Provider Demographics
NPI:1023273398
Name:MYER, RORY ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:RORY
Middle Name:ALEXANDER
Last Name:MYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:790 DUNLAWTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9279
Mailing Address - Country:US
Mailing Address - Phone:386-767-0053
Mailing Address - Fax:
Practice Address - Street 1:345 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3111
Practice Address - Country:US
Practice Address - Phone:386-672-4244
Practice Address - Fax:386-672-0603
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD74053207W00000X
FLME115632207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055411100Medicaid
MD055411100Medicaid
MD241084YYUMedicare PIN