Provider Demographics
NPI:1104860105
Name:MYERS, PAMELA A (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11082 S MILITARY TRL
Mailing Address - Street 2:SUITE B46
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7217
Mailing Address - Country:US
Mailing Address - Phone:561-740-3299
Mailing Address - Fax:561-740-3749
Practice Address - Street 1:11082 S MILITARY TRL
Practice Address - Street 2:SUITE B46
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7217
Practice Address - Country:US
Practice Address - Phone:561-740-3299
Practice Address - Fax:561-740-3749
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME072378207R00000X
FLME72378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY0206118Medicaid
FLG24359Medicare UPIN
NYNY0206118Medicaid