MEDICARE: MR. ROBERT PAUL MYERS D.O.

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	208000000X	Pediatrics Physician	35003507M	OH

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	:	1770676181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT PAUL MYERS D.O.

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	STE 201
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-438-1115
Fax Number	:	937-438-1291

Provider Business Practice Location Address
First Line	:	1516 YANKEE PARK PL
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1878
Country	:	US
Telephone Number	:	937-438-1115
Fax Number	:	937-438-1291

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	03/28/2016

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