Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D74053 | MD |
N | 207W00000X | Ophthalmologist | ME115632 | FL |
NPI | 1023273398 |
---|---|
Provider Name | Rory Alexander Myer |
First Address | Port Orange, FL 32127-9279 |
Second Address | Ormond Beach, FL 32174-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
055411100 | (05) | MD |
HH128Z | (02) | FL |