=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265539332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH PAUL MYERS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 ARCH ST SUITE 1-A
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44304-1423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-375-3742
-----------------------------------------------------
Fax | 330-375-3760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 ARCH ST SUITE 506
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44304-1429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-375-3894
-----------------------------------------------------
Fax | 330-375-6680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 35-040911
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------