MEDICARE: CODY MYERS PA-C

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	363AM0700X	Medical Physician Assistant	PA201290	OR

General Provider Information

NPI Number	:	1891310801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY MYERS PA-C

Provider Business Mailing Address
First Line	:	5329 NE MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3237
Country	:	US
Telephone Number	:	503-988-5558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 NW EVERETT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2915
Country	:	US
Telephone Number	:	888-663-6331
Fax Number	:	415-252-7176

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

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	01/07/2026

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Directions to “ CODY MYERS PA-C” Practice Location

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