Provider Demographics
NPI:1649256421
Name:MYERS, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GRAPEVINE MILLS PKWY STE 329-20
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2008
Mailing Address - Country:US
Mailing Address - Phone:214-285-0041
Mailing Address - Fax:
Practice Address - Street 1:3000 GRAPEVINE MILLS PKWY STE 329-20
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2008
Practice Address - Country:US
Practice Address - Phone:214-285-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7108208000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138988412Medicaid
TX8K9071OtherBCBS
TX84784FOtherBCBS
NM59155035Medicaid
TX138988416Medicaid
TX8V2870OtherBCBS
TX930045363OtherMEDICARE RAILROAD
TX138988416Medicaid
TX8F22589Medicare PIN
TX8G5083Medicare PIN
TX84784FMedicare PIN