Provider Demographics
NPI:1477620953
Name:MYERS, DAVID E (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:MYERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 21ST WAY S
Mailing Address - Street 2:ST 140
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3989
Mailing Address - Country:US
Mailing Address - Phone:205-939-0900
Mailing Address - Fax:
Practice Address - Street 1:1330 21ST WAY S
Practice Address - Street 2:ST 140
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3989
Practice Address - Country:US
Practice Address - Phone:205-939-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
51071270MYEOtherBLUE CROSS