Provider Demographics
NPI:1841285079
Name:MYER, THOMAS E (PSYDPA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:MYER
Suffix:
Gender:M
Credentials:PSYDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6029
Mailing Address - Country:US
Mailing Address - Phone:850-494-3917
Mailing Address - Fax:850-494-3960
Practice Address - Street 1:2191 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6029
Practice Address - Country:US
Practice Address - Phone:850-494-3917
Practice Address - Fax:850-494-3960
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101805363A00000X
FLPY3931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291146900Medicaid
FL73162YMedicare Oscar/Certification
FL73162ZMedicare ID - Type Unspecified
FL291146900Medicaid