Provider Demographics
NPI:1124845649
Name:MYERS, DALLAS C II (MS)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:C
Last Name:MYERS
Suffix:II
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DALE DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3958
Mailing Address - Country:US
Mailing Address - Phone:307-851-8975
Mailing Address - Fax:
Practice Address - Street 1:2 DALE DR
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3958
Practice Address - Country:US
Practice Address - Phone:307-851-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator