Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101018212 | VA |
NPI | 1033198346 |
---|---|
Provider Name | Dr. Alonzo Myers JR. |
First Address | Salem, VA 24153-7357 |
Second Address | Salem, VA 24153-7357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B10405 | (02) | |
P00276507 | MEDICARE RAILROAD (01) | VA |