Provider Demographics
NPI:1083657571
Name:MYERS, SEYMOUR (MD)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SEYMOUR
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13223 BLACK MOUNTAIN RD # 261
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2698
Mailing Address - Country:US
Mailing Address - Phone:619-972-3110
Mailing Address - Fax:858-273-7755
Practice Address - Street 1:9850 GENESEE AVE STE 320
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1208
Practice Address - Country:US
Practice Address - Phone:858-554-1212
Practice Address - Fax:858-554-1222
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG35184Medicare ID - Type Unspecified
CAA46246Medicare UPIN