Provider Demographics
NPI:1245398015
Name:MICHAEL D. MYERS, M.D., INC.
Entity Type:Organization
Organization Name:MICHAEL D. MYERS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-493-2266
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5403
Mailing Address - Country:US
Mailing Address - Phone:562-493-2266
Mailing Address - Fax:562-594-5020
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:STE 300
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5403
Practice Address - Country:US
Practice Address - Phone:562-493-2266
Practice Address - Fax:562-594-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G377160OtherBLUE SHIELD OF CA
CAG37716Medicare ID - Type Unspecified
CAG37716Medicare UPIN