Basic Information
| Provider Information | |||||||||
| NPI: | 1982992517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYERS | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E GUDE DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208501496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198509111 | ||||||||
| FaxNumber: | 9198502499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1418 E. MILLBROOK RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276094812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198509111 | ||||||||
| FaxNumber: | 9198502499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2011 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 00381 | KY | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213E00000X | 604 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.