Provider Demographics
NPI:1477514628
Name:MYERS, GARY HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HARRIS
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 1:10004 KENNERLY ROAD
Mailing Address - Street 2:SUITE 391B
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:314-843-8222
Mailing Address - Fax:314-843-1662
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 391B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-843-8222
Practice Address - Fax:314-843-1662
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTR55132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3833Medicare ID - Type Unspecified
A13128Medicare UPIN