MEDICARE: DR. MARK A MYERS MD

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	207RP1001X	Pulmonary Disease Physician	17750	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629075007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A MYERS MD

Provider Business Mailing Address
First Line	:	226 SE DEBELL
Second Line	:	BLDG A
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006
Country	:	US
Telephone Number	:	918-331-2599
Fax Number	:	918-331-2598

Provider Business Practice Location Address
First Line	:	3400 FRANK PHILLIPS
Second Line	:	SUITE 601
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006
Country	:	US
Telephone Number	:	918-331-2599
Fax Number	:	918-331-2598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/29/2011

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Directions to “ DR. MARK A MYERS MD” Practice Location

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