MEDICARE: MYERS DERMATOLOGY LLC

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	207N00000X	Dermatology Physician	MD202110	LA

General Provider Information

NPI Number	:	1114255965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYERS DERMATOLOGY LLC

Provider Business Mailing Address
First Line	:	5701 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-5181
Country	:	US
Telephone Number	:	337-456-3323
Fax Number	:	337-456-4638

Provider Business Practice Location Address
First Line	:	5701 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-5181
Country	:	US
Telephone Number	:	337-456-3323
Fax Number	:	337-456-4638

Authorized Official
Title or Position	:	DERMATOLOGIST
Name	:	DR. JENNIFER MARY MYERS
Credential	:	MD
Telephone Number	:	337-205-1914

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	02/10/2021

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