Basic Information
| Provider Information | |||||||||
| NPI: | 1609868546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 515 MINOR AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063869500 | ||||||||
| FaxNumber: | 2063869605 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 MINOR AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063869500 | ||||||||
| FaxNumber: | 2063869605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 27146 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | AZ0447780 | 01 | AZ | BLUE CROSS BLUE SHIELD | OTHER | P00330951 | 01 | AZ | RAILROAD MEDICARE | OTHER | 2Z9297 | 01 | AZ | HEALTH NET | OTHER | 5705879 | 01 | AZ | FIRST HEALTH | OTHER | 113738 | 05 | AZ | MEDICAID | 5902492 | 01 | AZ | CIGNA | OTHER | 1609868546 | 01 | AZ | AHCCCS | OTHER | 2668790 | 01 | AZ | UNITED HEALTHCARE | OTHER | 7524807 | 01 | AZ | AETNA | OTHER | 188961600 | 01 | AZ | DEPT OF LABOR WORK COMP | OTHER | 99S007000013 | 01 | MEDISUN | OTHER |