Provider Demographics
NPI:1528013703
Name:MYERS, CLIFFORD J (DO)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:J
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
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 244
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-0244
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:100 FAIR AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBOURNE
Practice Address - State:WV
Practice Address - Zip Code:26149-9622
Practice Address - Country:US
Practice Address - Phone:304-758-5100
Practice Address - Fax:304-758-4646
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042999000Medicaid
OH0803947Medicaid
F08322Medicare UPIN
WV0042999000Medicaid