Provider Demographics
NPI:1710986658
Name:MYERS, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:RR 3 BOX 142
Mailing Address - Street 2:HUNT CLUB PLAZA
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-9500
Mailing Address - Country:US
Mailing Address - Phone:304-726-4501
Mailing Address - Fax:304-726-4051
Practice Address - Street 1:RR 3 BOX 142
Practice Address - Street 2:HUNT CLUB PLAZA
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-9500
Practice Address - Country:US
Practice Address - Phone:304-726-4501
Practice Address - Fax:304-726-4051
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV13567207Q00000X
MDD32235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0056925000Medicaid
MD41843503OtherCAREFIRST BC BS
DCE458 0007OtherBLUE CHOICE BC BS
WV000513375OtherMT. STATE BC BS
080188048OtherTRAVELERS MEDICARE
A72246Medicare UPIN
DCE458 0007OtherBLUE CHOICE BC BS