1083972731 NPI number — GERALD A MAYER OD PA

Table of content: (NPI 1083972731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083972731 NPI number — GERALD A MAYER OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD A MAYER OD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083972731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7187 W OAKLAND PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUDERHILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33313-1050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-476-9654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7187 W OAKLAND PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUDERHILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33313-1050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-578-9599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MAYER
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-578-9599

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0844837 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com