Provider Demographics
NPI:1780779306
Name:MYERS, CLARA ANN (MD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:971 LAKELAND DRIVE
Mailing Address - Street 2:SUITE 1157
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-362-6900
Mailing Address - Fax:601-362-6111
Practice Address - Street 1:971 LAKELAND DRIVE
Practice Address - Street 2:SUITE 1157
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-362-6900
Practice Address - Fax:601-362-6111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS08780207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118847Medicaid
MS00118847Medicaid