Provider Demographics
NPI:1811948912
Name:MYERS, DEBRA ANN (LM)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 E GRAVES AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5266
Mailing Address - Country:US
Mailing Address - Phone:386-774-0712
Mailing Address - Fax:386-456-0712
Practice Address - Street 1:366 E GRAVES AVE
Practice Address - Street 2:STE A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-5266
Practice Address - Country:US
Practice Address - Phone:386-774-0712
Practice Address - Fax:386-456-0712
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW100176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114344OtherNON-PAR PROVIDER AETNA
FLY8947OtherNON-PAR PROVIDER BCBS