Provider Demographics
NPI:1881656775
Name:MYERS, JEROME BARTHOLOMEW (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:BARTHOLOMEW
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:2222 N NEVADA AVE
Mailing Address - Street 2:PENROSE HOSPITAL, DEPT. OF PATHOLOGY
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6819
Mailing Address - Country:US
Mailing Address - Phone:719-776-5991
Mailing Address - Fax:719-776-2108
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:PENROSE HOSPITAL, DEPT. OF PATHOLOGY
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:719-776-5991
Practice Address - Fax:719-776-2108
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44869207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67200052Medicaid
COP00370504OtherRAILROAD MEDICARE
COC806185Medicare PIN