Basic Information
| Provider Information | |||||||||
| NPI: | 1881012664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1272 GARRISON DR | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934480 | ||||||||
| FaxNumber: | 6158934480 | ||||||||
| Practice Location | |||||||||
| Address1: | 1272 GARRISON DR | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934480 | ||||||||
| FaxNumber: | 6158934480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207P00000X | R3573 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 49435 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD56137 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100374980 | 05 | KY | MEDICAID | Q021238 | 05 | TN | MEDICAID |