Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00185200 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00185200 | NJ |
NPI | 1023063799 |
---|---|
Provider Name | Dr. Earle Bruce Myers |
First Address | Hainesport, NJ 08036-2767 |
Second Address | Hainesport, NJ 08036-2767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3682102 | (05) | NJ |
T34716 | (02) | NJ |