Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 4218 | OK |
Y | 208200000X | Surgeon | 4218 | OK |
Y | 208600000X | Surgeon | 4218 | OK |
NPI | 1134204852 |
---|---|
Provider Name | Dr. William Jack Myers JR. |
First Address | Broken Arrow, OK 74012-8107 |
Second Address | Tahlequah, OK 74464-3324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 15/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I42887 | (02) | OK |