Basic Information
Provider Information
NPI: 1114292554
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYERS
FirstName: WILLIAM
MiddleName: TIMOTHY
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7400 KENNEDY LN
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452427527
CountryCode: US
TelephoneNumber: 5134787989
FaxNumber:  
Practice Location
Address1: 3333 BURNET AVE
Address2: ML 7015
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364225
FaxNumber: 5136362511
Other Information
ProviderEnumerationDate: 03/19/2012
LastUpdateDate: 04/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X35.126343OHY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home