Provider Demographics
NPI:1821064866
Name:MYERS, RAYMOND R (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:R
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 1:202 N DIVISION ST STE 202
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-4939
Mailing Address - Country:US
Mailing Address - Phone:253-846-8088
Mailing Address - Fax:253-846-8079
Practice Address - Street 1:202 N DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-846-8088
Practice Address - Fax:253-846-8079
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501488208000000X
WAMD60056481208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1143290OtherAETNA
NC561706219OtherPRACTICE TAX ID
NC14062OtherBCBS
NC5066580OtherCIGNA HEALTHCARE
NC5902378Medicaid
NC185617OtherMEDCOST
NCI44917Medicare UPIN