Provider Demographics
NPI:1982607867
Name:MYER, JONATHAN J (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:J
Last Name:MYER
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 1:6719 ALVARADO RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5256
Mailing Address - Country:US
Mailing Address - Phone:619-229-3932
Mailing Address - Fax:619-582-2860
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5256
Practice Address - Country:US
Practice Address - Phone:619-229-3932
Practice Address - Fax:619-582-2860
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83316207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A833160Medicaid
CAWA83316AOtherMEDICARE ID
CAI25678Medicare UPIN