Provider Demographics
NPI:1265566491
Name:MYERS, RICHARD A JR (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 18195
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122
Mailing Address - Country:US
Mailing Address - Phone:601-446-9850
Mailing Address - Fax:601-446-9833
Practice Address - Street 1:151 JEFF DAVIS BLVD STE H
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5140
Practice Address - Country:US
Practice Address - Phone:601-446-9850
Practice Address - Fax:601-446-9833
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80098213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115536Medicaid
LA1903906Medicaid
LA1903906Medicaid
MS00115536Medicaid