Provider Demographics
NPI:1972557163
Name:BYERS, CORNELIA MEI (MD)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:MEI
Last Name:BYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CRATER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6241
Mailing Address - Country:US
Mailing Address - Phone:541-734-0497
Mailing Address - Fax:541-732-6867
Practice Address - Street 1:1111 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6241
Practice Address - Country:US
Practice Address - Phone:541-734-0497
Practice Address - Fax:541-732-6867
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10740208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR140136OtherMEDICARE ID
OR284638Medicaid
ORC94272Medicare UPIN