Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 25MA06114100 | NJ |
N | 207W00000X | Ophthalmologist | C1005549 | DE |
Y | 207W00000X | Ophthalmologist | MD053800L | PA |
NPI | 1023013190 |
---|---|
Provider Name | Dr. Jonathan S Myers |
First Address | Philadelphia, PA 19107-5109 |
Second Address | Philadelphia, PA 19107-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1649751 | (05) | PA |
6265901 | (05) | NJ |
G00968 | (02) |