Basic Information
| Provider Information | |||||||||
| NPI: | 1336180082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 MISSION POINT BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454316600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379124441 | ||||||||
| FaxNumber: | 9374294236 | ||||||||
| Practice Location | |||||||||
| Address1: | 4164 BURBANK RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446919077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303458032 | ||||||||
| FaxNumber: | 3303458072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.039262 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0335060 | 05 | OH | MEDICAID |