Provider Demographics
NPI:1982641957
Name:MYERS, DAVID GEOFFREY MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEOFFREY MARTIN
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:534 PLEASANT VIEW WAY NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1789
Practice Address - Country:US
Practice Address - Phone:541-812-5656
Practice Address - Fax:541-812-5660
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO28598207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024493Medicaid
CAW20A9280AMedicare PIN