Individual
JACK EDWARD MEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
75 FRANCIS ST, RADIOLOGY BRIGHAM & WOMENS HOSPITAL, BOSTON, MA 02115-6110
(617) 732-6269
(617) 525-7333
Mailing address
75 FRANCIS ST, RADIOLOGY BRIGHAM & WOMENS HOSPITAL, BOSTON, MA 02115-6110
(617) 732-6269
(617) 525-7333
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
30650
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2085151
—
MA
01
—
760044
TUFTS HEALTH PLAN
MA
01
—
M07917
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/16/2005
Last updated
09/12/2012
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