Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD2008-0464 | NM |
N | 207PP0204X | Pediatric Emergency Physician | MD2008-0464 | NM |
NPI | 1285890269 |
---|---|
Provider Name | Randall T Myers |
First Address | Albuquerque, NM 87102-1726 |
Second Address | Albuquerque, NM 87106-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 30/07/2008 |