MEDICARE: KENT W. MYERS, MD, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	19579	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1508813965	OTHER	AZ	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1598044984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT W. MYERS, MD, PLC

Provider Business Mailing Address
First Line	:	9965 W ROYAL OAK RD
Second Line	:	SUITE # 2236
City	:	SUN CITY
State	:	AZ
Zip	:	85351-6109
Country	:	US
Telephone Number	:	623-815-0210
Fax Number	:	623-815-0212

Provider Business Practice Location Address
First Line	:	9965 W ROYAL OAK RD
Second Line	:	SUITE # 2236
City	:	SUN CITY
State	:	AZ
Zip	:	85351-6109
Country	:	US
Telephone Number	:	623-815-0210
Fax Number	:	623-815-0212

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. PAUL M SHANAHAN
Credential	:
Telephone Number	:	623-974-6611

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/16/2011

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