Provider Demographics
NPI:1538452719
Name:MEYKLER, SIMON E (DO)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:E
Last Name:MEYKLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 QUANTUM RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4506
Mailing Address - Country:US
Mailing Address - Phone:505-924-0209
Mailing Address - Fax:505-924-0210
Practice Address - Street 1:640 QUANTUM RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4506
Practice Address - Country:US
Practice Address - Phone:505-924-0209
Practice Address - Fax:505-924-0210
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014140390200000X
NMA-1945-16207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program