Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | L0442 | TX |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | L0442 | TX |
NPI | 1285603035 |
---|---|
Provider Name | Larry Leonard Myers JR. |
First Address | Dallas, TX 75390-7201 |
Second Address | Dallas, TX 75390-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G85013 | (02) |