Provider Demographics
NPI:1669439857
Name:MYERS, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:55 E CALIFORNIA BLVD
Mailing Address - Street 2:3RD FL
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3944
Mailing Address - Country:US
Mailing Address - Phone:626-793-1227
Mailing Address - Fax:626-793-3794
Practice Address - Street 1:55 E CALIFORNIA BLVD
Practice Address - Street 2:3RD FL
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3944
Practice Address - Country:US
Practice Address - Phone:626-793-1227
Practice Address - Fax:626-793-3794
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50231207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00097733OtherRAIL ROAD MEDICARE
CAG50231OtherBLUE SHIELD
CAP00097733OtherRAIL ROAD MEDICARE
CAWG50231CMedicare ID - Type Unspecified