Provider Demographics
NPI:1982662086
Name:MYERS, KEVIN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DOUGLAS
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:251 COHASSET RD
Mailing Address - Street 2:STE 340
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2241
Mailing Address - Country:US
Mailing Address - Phone:530-345-5900
Mailing Address - Fax:530-345-5995
Practice Address - Street 1:251 COHASSET RD
Practice Address - Street 2:STE 340
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2241
Practice Address - Country:US
Practice Address - Phone:530-345-5900
Practice Address - Fax:530-345-5995
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA793592086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982662086Medicaid
CAH67110Medicare UPIN
CA1982662086Medicaid