Provider Demographics
NPI:1437108537
Name:MYERS, DOUGLAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 E MILL PLAIN BLVD
Mailing Address - Street 2:STE #100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664
Mailing Address - Country:US
Mailing Address - Phone:360-254-7725
Mailing Address - Fax:360-254-7727
Practice Address - Street 1:8614 E MILL PLAIN BLVD
Practice Address - Street 2:STE #100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-254-7725
Practice Address - Fax:360-254-7727
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21689207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1031236Medicaid
000615195Medicare ID - Type Unspecified
WA1031236Medicaid