Provider Demographics
NPI:1467434456
Name:MYERS, JOHN DEMPSEY II (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DEMPSEY
Last Name:MYERS
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-0270
Mailing Address - Country:US
Mailing Address - Phone:903-723-2465
Mailing Address - Fax:903-677-5586
Practice Address - Street 1:510 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3410
Practice Address - Country:US
Practice Address - Phone:903-731-1000
Practice Address - Fax:903-677-5586
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1347825-04Medicaid
TX1347825-05Medicaid
TX1347825-05Medicaid
TX1347825-04Medicaid
88368CMedicare PIN