Provider Demographics
NPI:1740288158
Name:MYERS, STANLEY A (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:A
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2230 NW PETTYGROVE ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2659
Mailing Address - Country:US
Mailing Address - Phone:503-223-6223
Mailing Address - Fax:503-223-3665
Practice Address - Street 1:2230 NW PETTYGROVE ST
Practice Address - Street 2:STE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-223-6223
Practice Address - Fax:503-223-3665
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000034615208800000X
ORMD18423208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8207136Medicaid
WA8207136Medicaid
WAGAB34517Medicare PIN
F11771Medicare UPIN