Basic Information
| Provider Information | |||||||||
| NPI: | 1295103265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050A 2ND ST SE | ||||||||
| Address2: | |||||||||
| City: | KIRTLAND AFB | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871175522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058463562 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2050A 2ND ST SE | ||||||||
| Address2: | |||||||||
| City: | KIRTLAND AFB | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871175522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058463562 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2015 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.