Provider Demographics
NPI:1063635225
Name:MYERS, JED A (MD)
Entity Type:Individual
Prefix:
First Name:JED
Middle Name:A
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 1:4026 NE 55TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2262
Mailing Address - Country:US
Mailing Address - Phone:206-526-0972
Mailing Address - Fax:206-528-5675
Practice Address - Street 1:4026 NE 55TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2262
Practice Address - Country:US
Practice Address - Phone:206-526-0972
Practice Address - Fax:206-528-5675
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020504174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist