Provider Demographics
NPI:1679566202
Name:MYERS, BRENT MARK (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MARK
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:PO BOX 60517
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906
Mailing Address - Country:US
Mailing Address - Phone:239-561-7337
Mailing Address - Fax:239-768-3129
Practice Address - Street 1:8380 RIVERWALK PARK BLVD
Practice Address - Street 2:STE 200
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-561-7337
Practice Address - Fax:239-768-3129
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57733207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Not Answered207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
68571WMedicare ID - Type Unspecified
E20892Medicare UPIN