Provider Demographics
NPI:1437217304
Name:MYERS, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:90 SOUTH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4328
Mailing Address - Country:US
Mailing Address - Phone:518-792-7323
Mailing Address - Fax:518-792-5883
Practice Address - Street 1:90 SOUTH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4328
Practice Address - Country:US
Practice Address - Phone:518-792-7323
Practice Address - Fax:518-792-5883
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYMD1081082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00359173Medicaid
30542BMedicare UPIN
NY00359173Medicaid