Provider Demographics
NPI:1003172255
Name:MYERS, EARL FREDERICK III (CST/CSFA, BSC)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:FREDERICK
Last Name:MYERS
Suffix:III
Gender:M
Credentials:CST/CSFA, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2417
Mailing Address - Country:US
Mailing Address - Phone:717-575-7315
Mailing Address - Fax:
Practice Address - Street 1:1504 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2417
Practice Address - Country:US
Practice Address - Phone:717-575-7315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA132335246ZS0410X
PA140000246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist