Individual
JACK R MEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 PATRIOT DR, LITTLE CHUTE, WI 54140-1184
(920) 687-2800
Mailing address
200 PATRIOT DR, LITTLE CHUTE, WI 54140-1184
(920) 687-2800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27277
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30756500
—
WI
Enumeration date
09/09/2005
Last updated
09/04/2008
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