Provider Demographics
NPI:1255425252
Name:MYERS, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
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 1:680 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2241
Mailing Address - Country:US
Mailing Address - Phone:801-768-8800
Mailing Address - Fax:
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2241
Practice Address - Country:US
Practice Address - Phone:801-768-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55125207N00000X
WI50779-020207N00000X
UT7905788-1205207N00000X
ID11577207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000074577Medicare PIN