Provider Demographics
NPI:1245238039
Name:MYERS, BARRY MORGAN (PA)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:MORGAN
Last Name:MYERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 SPRINGPORT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1475
Mailing Address - Country:US
Mailing Address - Phone:517-784-3950
Mailing Address - Fax:517-783-2728
Practice Address - Street 1:308 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1678
Practice Address - Country:US
Practice Address - Phone:517-787-5970
Practice Address - Fax:517-787-3353
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004483363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR70837Medicare UPIN