Provider Demographics
NPI:1669420022
Name:MYERS, EARL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:JOSEPH
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1904 JAKE ALEXANDER BLVD W STE 301
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1177
Practice Address - Country:US
Practice Address - Phone:704-638-1551
Practice Address - Fax:704-638-1553
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000913207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127PNMedicaid
SCQ0091FMedicaid
NC127PNOtherBCBS
930098625Medicare PIN
NC2281320Medicare PIN
NC89127PNMedicaid