Provider Demographics
NPI:1194755181
Name:MYERS, GREGORY JAY (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAY
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:480 HOPKINSVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-5777
Mailing Address - Fax:270-338-5765
Practice Address - Street 1:10220 DIXIE BEELINE HIGHWAY
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:KY
Practice Address - Zip Code:42234-9310
Practice Address - Country:US
Practice Address - Phone:270-220-0340
Practice Address - Fax:270-220-0341
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL30319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100451250Medicaid
KY611268014OtherFEDERAL TAX ID#