Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 43155 | MA |
NPI | 1013043603 |
---|---|
Provider Name | John A Myers |
First Address | Concord, MA 01742-4417 |
Second Address | Medford, MA 02155-5816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |