Provider Demographics
NPI:1558302133
Name:MYERS, BEHNAM (DO)
Entity type:Individual
Prefix:
First Name:BEHNAM
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3634
Mailing Address - Country:US
Mailing Address - Phone:954-983-3888
Mailing Address - Fax:954-983-3999
Practice Address - Street 1:3850 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3634
Practice Address - Country:US
Practice Address - Phone:954-983-3888
Practice Address - Fax:954-983-3999
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8934207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277510700Medicaid
FL53147OtherBLUE CROSS BLUE SHIELD
FL277510700Medicaid
FLI21614Medicare UPIN