MEDICARE: JOHN MIERS DO

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1063464691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN MIERS DO

Provider Business Mailing Address
First Line	:	1650 W MAGNOLIA AVE
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4009
Country	:	US
Telephone Number	:	817-926-1333
Fax Number	:	817-927-2528

Provider Business Practice Location Address
First Line	:	1650 W MAGNOLIA AVE
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4009
Country	:	US
Telephone Number	:	817-926-1333
Fax Number	:	817-927-2528

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN MIERS
Credential	:	DO
Telephone Number	:	817-926-1333

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	05/23/2008

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