Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 01038556A | IN |
NPI | 1003856915 |
---|---|
Provider Name | John M Myers |
First Address | Evansville, IN 47731-3276 |
Second Address | Evansville, IN 47750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 26/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000040941 | BLUE SHIELD (01) | IN |
050029310 | RAILROAD MEDICARE (01) | |
100341730 | (05) | IN |
64875867 | (05) | KY |
F57033 | (02) |