Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 8203 | NH |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 8203 | NH |
NPI | 1609956093 |
---|---|
Provider Name | Mr. Bruce R Myers |
First Address | Boston, MA 02241-2503 |
Second Address | Portsmouth, NH 03801-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3074297 | (05) | NH |
E12443 | (02) |