Provider Demographics
NPI:1598816696
Name:MYERS, DAVID ALLEN
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:MYERS
Suffix:
Gender:M
Credentials:
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 55730
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70055-5730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 METAIRIE RD
Practice Address - Street 2:STE. 2A-202
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4050
Practice Address - Country:US
Practice Address - Phone:504-833-9440
Practice Address - Fax:504-833-1312
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1492264Medicaid
LA1492264Medicaid
G74298Medicare UPIN