Provider Demographics
NPI:1548393671
Name:MYERS, PAUL R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:MYERS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:120 2ND ST
Mailing Address - Street 2:CHW-FV, NICU
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2883
Mailing Address - Country:US
Mailing Address - Phone:920-969-7990
Mailing Address - Fax:920-722-4224
Practice Address - Street 1:120 2ND ST
Practice Address - Street 2:CHW-FV, NICU
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-969-7990
Practice Address - Fax:920-722-4224
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI308552080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31545700Medicaid
WI31545700Medicaid