Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 01086434A | IN |
NPI | 1023632429 |
---|---|
Provider Name | Dr. Brandon Lee Myers |
First Address | Apo, AP 96218-0024 |
Second Address | Apo, AP 96271-5245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2020 |
Last Update Date | 31/08/2021 |