MEDICARE: DR. DALE R MYERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	7160A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	313292	OTHER	WY	BCBS

General Provider Information

NPI Number	:	1053312827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE R MYERS MD

Provider Business Mailing Address
First Line	:	721 SHERIDAN AVE
Second Line	:	SUITE 220
City	:	CODY
State	:	WY
Zip	:	82414-3423
Country	:	US
Telephone Number	:	307-587-1155
Fax Number	:	307-587-1166

Provider Business Practice Location Address
First Line	:	721 SHERIDAN AVE
Second Line	:	SUITE 220
City	:	CODY
State	:	WY
Zip	:	82414-3423
Country	:	US
Telephone Number	:	307-587-1155
Fax Number	:	307-587-1166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/23/2007

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