Provider Demographics
NPI:1699828723
Name:MYERS, CHARLES EUGENE (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EUGENE
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3306 W ROOSEVELT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-3404
Mailing Address - Country:US
Mailing Address - Phone:602-278-4930
Mailing Address - Fax:
Practice Address - Street 1:3306 W ROOSEVELT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3404
Practice Address - Country:US
Practice Address - Phone:602-278-4930
Practice Address - Fax:602-269-7772
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47302Medicare UPIN