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General NPI Number Information
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NPI Number | 1932488608
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Entity Type | Individual
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Provider Name | MARC JOSEPH MYER MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 12081 285TH ST
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City | LINDSTROM
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State | MN
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Zip | 55045-8084
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Country | US
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Telephone | 612-393-1212
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Fax | 651-400-3892
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Provider Business Mailing Address
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Address Line | PO BOX 833
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City | LINDSTROM
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State | MN
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Zip | 55045-0833
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Country | US
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Telephone | 612-393-1212
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Fax | 651-400-3892
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 43740
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 61-22856
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License Number State | MN
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