Provider Demographics
NPI:1740433317
Name:MYERS, ISAAC JORDAN II (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:JORDAN
Last Name:MYERS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9145 NAUTICAL WATCH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9036
Mailing Address - Country:US
Mailing Address - Phone:317-308-1664
Mailing Address - Fax:317-826-7437
Practice Address - Street 1:9145 NAUTICAL WATCH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9036
Practice Address - Country:US
Practice Address - Phone:317-308-1664
Practice Address - Fax:317-826-7437
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038719A302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization