Healthcare Provider Details

I. General information

NPI: 1881671915
Provider Name (Legal Business Name): DANNY WADELL MYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 JEFFERSON AVE
FORT EUSTIS VA
23604-1602
US

IV. Provider business mailing address

158 STONE LAKE CT
YORKTOWN VA
23693-3714
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7606
  • Fax: 757-314-7726
Mailing address:
  • Phone: 757-865-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number46840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: