MEDICARE: MR. MICHAEL BLAINE MYERS PA-C

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	363AS0400X	Surgical Physician Assistant	PA05007	TX

General Provider Information

NPI Number	:	1194898957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL BLAINE MYERS PA-C

Provider Business Mailing Address
First Line	:	3256 SAILMAKER LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-3609
Country	:	US
Telephone Number	:	214-227-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 W MAIN ST
Second Line	:	SUITE 150
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-3628
Country	:	US
Telephone Number	:	972-420-8500
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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