MEDICARE: STANLEY A MYERS M.D.

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	208800000X	Urology Physician	MD000034615	WA
2	208800000X	Urology Physician	MD18423	OR

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

General Provider Information

NPI Number	:	1740288158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY A MYERS M.D.

Provider Business Mailing Address
First Line	:	2230 NW PETTYGROVE ST
Second Line	:	STE 210
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-223-6223
Fax Number	:	503-223-3665

Provider Business Practice Location Address
First Line	:	2230 NW PETTYGROVE ST
Second Line	:	STE 210
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-223-6223
Fax Number	:	503-223-3665

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	05/03/2012

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Directions to “ STANLEY A MYERS M.D.” Practice Location

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