Provider Demographics
NPI:1134306947
Name:MYERS, GERALD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PAUL
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:54354 OLD BEDFORD TRL
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1513
Mailing Address - Country:US
Mailing Address - Phone:219-874-7256
Mailing Address - Fax:219-879-9839
Practice Address - Street 1:3 PARK ROW
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-874-7256
Practice Address - Fax:219-879-9839
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025704207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC25552Medicare UPIN