Provider Demographics
NPI:1275572521
Name:MYERS, ROY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:ALLEN
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 1:411 FORTUYN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND COULEE
Mailing Address - State:WA
Mailing Address - Zip Code:99133-8718
Mailing Address - Country:US
Mailing Address - Phone:509-633-1911
Mailing Address - Fax:509-633-1930
Practice Address - Street 1:411 FORTUYN RD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-8718
Practice Address - Country:US
Practice Address - Phone:509-633-1911
Practice Address - Fax:509-633-1933
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1006570Medicaid
WA8858304Medicare ID - Type UnspecifiedMEDICARE
WA8233611Medicaid
WA0016909OtherBCC LABOR & INDUSTRIES #
WA7600067Medicaid
WA7016165Medicaid
WA7064801Medicaid
WA503820Medicare ID - Type UnspecifiedBCC MEDICARE PROVIDER #
WA0204160OtherLABOR AND INDUSTRIES