Basic Information
| Provider Information | |||||||||
| NPI: | 1578525762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3188 | ||||||||
| Address2: | |||||||||
| City: | OMAK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988413188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098261600 | ||||||||
| FaxNumber: | 5098263617 | ||||||||
| Practice Location | |||||||||
| Address1: | 529 JASMINE ST | ||||||||
| Address2: | |||||||||
| City: | OMAK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988419589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098261600 | ||||||||
| FaxNumber: | 5098263617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD00018262 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0223469 | 01 | WA | LABOR & INDUSTRY | OTHER | 8229502 | 05 | WA | MEDICAID |