Provider Demographics
NPI:1245285949
Name:MYERS, CHARLES JEFFREY (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JEFFREY
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:5177 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:765-738-6300
Practice Address - Fax:765-838-6302
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801415207V00000X
IN01053447A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200328930Medicaid
NC14517OtherBCBS
NC5907266Medicaid
IN000000848856OtherANTHEM PIN NUMBER
IN000000848856OtherANTHEM PIN NUMBER
IN815500046Medicare PIN
NC5907266Medicaid
NC2071273Medicare PIN