Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 7160A | WY |
NPI | 1053312827 |
---|---|
Provider Name | Dr. Dale R Myers |
First Address | Cody, WY 82414-3423 |
Second Address | Cody, WY 82414-3423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 23/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
313292 | BCBS (01) | WY |
F33500 | (02) |