Provider Demographics
NPI:1700808433
Name:MIERS, JEB STUART (MD)
Entity type:Individual
Prefix:DR
First Name:JEB
Middle Name:STUART
Last Name:MIERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN STE 812
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4410
Mailing Address - Country:US
Mailing Address - Phone:214-696-1118
Mailing Address - Fax:214-696-4447
Practice Address - Street 1:8210 WALNUT HILL LN STE 812
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4410
Practice Address - Country:US
Practice Address - Phone:214-696-1118
Practice Address - Fax:214-696-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSOther8X2730
TX00W829Medicare ID - Type UnspecifiedGROUP ID
TXBCBSOther8X2730
TX8F3566Medicare ID - Type UnspecifiedINDV ID NUMBER
TXC19364Medicare UPIN