Provider Demographics
NPI:1730345950
Name:MEYER, WESLEY ALVIN (DO)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:ALVIN
Last Name:MEYER
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 1:4920 S 30TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1590
Mailing Address - Country:US
Mailing Address - Phone:402-734-4110
Mailing Address - Fax:
Practice Address - Street 1:4920 S 30TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1590
Practice Address - Country:US
Practice Address - Phone:402-734-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017176208000000X
NE1027208000000X
MN55124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics