Provider Demographics
NPI:1083893127
Name:DALE R MYERS MD PC
Entity Type:Organization
Organization Name:DALE R MYERS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-587-1155
Mailing Address - Street 1:1613 STAMPEDE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4710
Mailing Address - Country:US
Mailing Address - Phone:307-587-1155
Mailing Address - Fax:307-587-1166
Practice Address - Street 1:1613 STAMPEDE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4710
Practice Address - Country:US
Practice Address - Phone:307-587-1155
Practice Address - Fax:307-587-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7160A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120532300Medicaid
WY313292OtherBCBS
WYF33500Medicare UPIN
WY20102Medicare PIN