Healthcare Provider Details

I. General information

NPI: 1295103265
Provider Name (Legal Business Name): ADAM DAVID MYERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050A 2ND ST SE
KIRTLAND AFB NM
87117-5522
US

IV. Provider business mailing address

2050A 2ND ST SE
KIRTLAND AFB NM
87117-5522
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-3562
  • Fax:
Mailing address:
  • Phone: 505-846-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: