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General NPI Number Information
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NPI Number | 1134306947
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Entity Type | Individual
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Provider Name | GERALD PAUL MYERS MD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 3 PARK ROW
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City | MICHIGAN CITY
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State | IN
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Zip | 46360
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Country | US
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Telephone | 219-874-7256
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Fax | 219-879-9839
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Provider Business Mailing Address
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Address Line | 54354 OLD BEDFORD TRL
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City | MISHAWAKA
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State | IN
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Zip | 46545-1513
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Country | US
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Telephone | 219-874-7256
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Fax | 219-879-9839
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 01025704
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License Number State | IN
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