Healthcare Provider Details

I. General information

NPI: 1366685166
Provider Name (Legal Business Name): RICHARD JOHN MYERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MULLAN RD STE C
MISSOULA MT
59808-1811
US

IV. Provider business mailing address

2360 MULLAN RD STE C
MISSOULA MT
59808-1811
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-4436
  • Fax: 406-721-6053
Mailing address:
  • Phone: 406-721-4436
  • Fax: 406-721-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101257708
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD161746
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2016-00601
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2016-00601
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number0101257708
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMED-PHYS-LIC-116543
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: