Organization Name: | TODD R MYERS MD LLC |
NPI Number: | 1184914947 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TODD R MYERS (OWNER) |
Mailing Address: | 1113 Washington St Suite 203 Ravenswood |
State: | WV US |
Postal Code: | 261641020 |
Phone Number: | 3042739482 |
Fax Number: | |
NPI Enumeration Date: | 04/13/2011 |
NPI Last Update Date: | 04/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 19171 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |