Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 19171 | WV |
Y | 207V00000X | Obstetrician & Gynecologist | 35075798M | OH |
NPI | 1023011673 |
---|---|
Provider Name | Todd Richard Myers |
First Address | Marietta, OH 45750-0449 |
Second Address | Marietta, OH 45750-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 22/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0093561000 | (05) | WV |
2150925 | (05) | OH |
G73568 | (02) | |
P01331374 | RAILROAD MEDICARE - MHCPI (01) | OH |