Provider Demographics
NPI:1962533083
Name:MYERS, MICHELLE LEIGH (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEIGH
Last Name:MYERS
Suffix:
Gender:F
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:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0587
Mailing Address - Country:US
Mailing Address - Phone:208-814-7400
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:746 N COLLEGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3486
Practice Address - Country:US
Practice Address - Phone:208-814-7230
Practice Address - Fax:208-734-1178
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0524207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808322000Medicaid
IDP00809349OtherMCRR
ID1302913Medicare PIN
IDP00809349OtherMCRR