Basic Information
| Provider Information | |||||||||
| NPI: | 1679612071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 MYRTLE ST STE 160 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165024602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144569197 | ||||||||
| FaxNumber: | 8144552765 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 MYRTLE ST STE 160 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165024602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144569197 | ||||||||
| FaxNumber: | 8144552765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD456732 | PA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 261044200 | 05 | FL | MEDICAID |