Individual
MARK AMES MEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 N BROADWAY, PERU, IN 46970-1070
(765) 472-5335
(765) 472-5468
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01035273A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000592124
ANTHEM
IN
01
—
000000738897
ANTHEM PROVIDER NUMBER UNDER TIN 35-2030653
IN
05
—
100344710
—
IN
Enumeration date
06/01/2005
Last updated
03/25/2015
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