Provider Demographics
NPI:1205806304
Name:MYERS, EDWARD GLENN (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GLENN
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Suffix:
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Mailing Address - Street 1:6520 STATE ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9667
Mailing Address - Country:US
Mailing Address - Phone:330-637-4964
Mailing Address - Fax:
Practice Address - Street 1:2581 NORTH RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3052
Practice Address - Country:US
Practice Address - Phone:330-372-5200
Practice Address - Fax:330-372-4437
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH4585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE75578Medicare UPIN