Basic Information
| Provider Information | |||||||||
| NPI: | 1124050265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MESCHLER | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17389 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802170389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254071000 | ||||||||
| FaxNumber: | 4254071112 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BALSAM AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034157000 | ||||||||
| FaxNumber: | 4254071112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 058074 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 058074 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | DR0055201 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 808556222A | 05 | GA | MEDICAID | 1124050265 | 05 | CO | MEDICAID |