Provider Demographics
NPI:1689715849
Name:MEYER, D.O.M., JEFFREY LEE (DOM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:MEYER, D.O.M.
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BALSA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8319
Mailing Address - Country:US
Mailing Address - Phone:505-690-7758
Mailing Address - Fax:505-466-2772
Practice Address - Street 1:3 N CHAMISA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9463
Practice Address - Country:US
Practice Address - Phone:505-466-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM486171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist