Provider Demographics
NPI:1861417941
Name:MYERS, ROBERT KEMP SR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEMP
Last Name:MYERS
Suffix:SR
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:PO BOX 2119
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-2119
Mailing Address - Country:US
Mailing Address - Phone:270-351-2671
Mailing Address - Fax:
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:270-706-1651
Practice Address - Fax:270-706-1058
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000518773OtherANTHEM BCBS
KY50014791OtherPASSPORT
KY64172083Medicaid
KY4054074OtherCIGNA
KY2843002000OtherPASSPORT ADVANTAGE
KY000000518773OtherANTHEM BCBS
KYC73917Medicare UPIN
KY00011018Medicare PIN