Provider Demographics
NPI:1881012219
Name:MYERS, GORDON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:EDWARD
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 1:7495 STATE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-6403
Mailing Address - Country:US
Mailing Address - Phone:513-861-0222
Mailing Address - Fax:513-231-0337
Practice Address - Street 1:7495 STATE RD STE 350
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6403
Practice Address - Country:US
Practice Address - Phone:513-861-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136134207K00000X
LA306072208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology