Provider Demographics
NPI:1053312827
Name:MYERS, DALE R (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 SHERIDAN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3423
Mailing Address - Country:US
Mailing Address - Phone:307-587-1155
Mailing Address - Fax:307-587-1166
Practice Address - Street 1:721 SHERIDAN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3423
Practice Address - Country:US
Practice Address - Phone:307-587-1155
Practice Address - Fax:307-587-1166
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7160A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313292OtherBCBS
WY20102Medicare ID - Type Unspecified
F33500Medicare UPIN