Provider Demographics
NPI:1003140260
Name:MYERS, CRAIG A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:MYERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 74692
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0002
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:25200 CENTER RIDGE ROAD
Practice Address - Street 2:SUITE 3400
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4145
Practice Address - Country:US
Practice Address - Phone:440-331-4646
Practice Address - Fax:440-331-3197
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001369363A00000X
OH50-001369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant