Provider Demographics
NPI:1760594907
Name:MYERS, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:MYERS
Suffix:
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 1:535 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-1988
Mailing Address - Country:US
Mailing Address - Phone:775-635-2424
Mailing Address - Fax:775-635-2437
Practice Address - Street 1:535 S HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-1988
Practice Address - Country:US
Practice Address - Phone:775-635-2424
Practice Address - Fax:775-635-2437
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6106207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805566800Medicaid
V104456OtherMEDICARE PTAN
V104456OtherMEDICARE PTAN
1142346Medicare ID - Type Unspecified