Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 43740 | MN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 61-22856 | MN |
NPI | 1932488608 |
---|---|
Provider Name | Dr. Marc Joseph Myer |
First Address | Lindstrom, MN 55045-0833 |
Second Address | Lindstrom, MN 55045-8084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2011 |
Last Update Date | 01/04/2021 |