Provider Demographics
NPI:1770676181
Name:MYERS, ROBERT PAUL (DO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PAUL
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-438-1115
Mailing Address - Fax:937-438-1291
Practice Address - Street 1:1516 YANKEE PARK PL
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1878
Practice Address - Country:US
Practice Address - Phone:937-438-1115
Practice Address - Fax:937-438-1291
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35003507M208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0559864Medicaid
OH0559864Medicaid
OHMY4156641Medicare ID - Type Unspecified