Provider Demographics
NPI:1134105729
Name:MYERS, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
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 1:860 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1800
Mailing Address - Country:US
Mailing Address - Phone:740-454-4651
Mailing Address - Fax:740-454-4653
Practice Address - Street 1:4063 N POINTE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7647
Practice Address - Country:US
Practice Address - Phone:740-452-1905
Practice Address - Fax:740-452-4117
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052206M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1586OtherGROUP MEDICARE RAILROAD
OH0617416Medicaid
OH080025058OtherMEDICARE RAILROAD
OH0989499OtherGROUP MEDICAID
MY0770343OtherMEDICARE PTAN
OH311413469047OtherCARESOURCE PIN
OH000000019408OtherANTHEM PIN
OH000000177771OtherUNISON PIN
OH0101037OtherUHC PIN
OH000000019408OtherANTHEM PIN
OH0101037OtherUHC PIN
CA1586OtherGROUP MEDICARE RAILROAD