Provider Demographics
NPI:1073540969
Name:MYERS, JOEL (PA C)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
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:PO BOX 4931
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-4931
Mailing Address - Country:US
Mailing Address - Phone:541-203-3110
Mailing Address - Fax:
Practice Address - Street 1:17054 INDIO RD #4931
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97707
Practice Address - Country:US
Practice Address - Phone:541-203-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01053207P00000X, 207Q00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500606276Medicaid
MY1970OtherNEP
WAS94681Medicare UPIN