Healthcare Provider Details

I. General information

NPI: 1437217304
Provider Name (Legal Business Name): JOHN MICHAEL MYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SOUTH ST SUITE B
GLENS FALLS NY
12801-4328
US

IV. Provider business mailing address

90 SOUTH ST SUITE B
GLENS FALLS NY
12801-4328
US

V. Phone/Fax

Practice location:
  • Phone: 518-792-7323
  • Fax: 518-792-5883
Mailing address:
  • Phone: 518-792-7323
  • Fax: 518-792-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD108108
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: