Provider Demographics
NPI:1003254525
Name:MYERS, PHILIP D (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15190 COMMUNITY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3484
Mailing Address - Country:US
Mailing Address - Phone:228-205-6825
Mailing Address - Fax:228-831-8782
Practice Address - Street 1:15190 COMMUNITY RD STE 120
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3484
Practice Address - Country:US
Practice Address - Phone:228-205-6825
Practice Address - Fax:228-831-8782
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS26837207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009606852Medicaid