Provider Demographics
NPI:1578624490
Name:MYERS, BRYAN D (MPAS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:MYERS
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1356 126TH RD
Mailing Address - Street 2:
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-6240
Mailing Address - Country:US
Mailing Address - Phone:402-764-2491
Mailing Address - Fax:402-764-4033
Practice Address - Street 1:302 E 4TH ST
Practice Address - Street 2:
Practice Address - City:STROMBERG
Practice Address - State:NE
Practice Address - Zip Code:68666-0546
Practice Address - Country:US
Practice Address - Phone:402-764-2491
Practice Address - Fax:402-764-4033
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096769-003Medicare PIN