Provider Demographics
NPI:1194788794
Name:MYERS, JAMES MARK (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:920 HILLTOP
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802
Mailing Address - Country:US
Mailing Address - Phone:479-967-0799
Mailing Address - Fax:479-967-0798
Practice Address - Street 1:1808 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801
Practice Address - Country:US
Practice Address - Phone:479-967-0799
Practice Address - Fax:479-967-0798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5125208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D84300Medicare UPIN
53813Medicare ID - Type Unspecified