Provider Demographics
NPI:1609956093
Name:MYERS, BRUCE R (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:R
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 412503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2503
Mailing Address - Country:US
Mailing Address - Phone:603-431-5529
Mailing Address - Fax:603-436-6603
Practice Address - Street 1:67 CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2847
Practice Address - Country:US
Practice Address - Phone:603-431-5529
Practice Address - Fax:603-436-6603
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH8203204C00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074297Medicaid
NHRE0268Medicare ID - Type Unspecified