Provider Demographics
NPI:1386950384
Name:MYERS, PEARL GIZELLE (MD)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:GIZELLE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAYER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3348
Mailing Address - Country:US
Mailing Address - Phone:601-520-4268
Mailing Address - Fax:
Practice Address - Street 1:155 CROSS CREEK PKWY
Practice Address - Street 2:APT 315
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-4434
Practice Address - Country:US
Practice Address - Phone:601-520-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296142-1207ZP0101X, 207ZP0102X
SC30590207ZP0101X
MS21283207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology