Provider Demographics
NPI:1316946171
Name:MYERS, JEFFREY PAUL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4557
Mailing Address - Country:US
Mailing Address - Phone:972-475-0960
Mailing Address - Fax:972-412-5219
Practice Address - Street 1:9500 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4557
Practice Address - Country:US
Practice Address - Phone:972-475-0960
Practice Address - Fax:972-412-5219
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2010-06-18
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXG5420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168352601Medicaid
TX8K0723OtherMEDICARE INDIVIDUAL
TX168352601Medicaid