Provider Demographics
NPI:1316984354
Name:MYERS, RICHARD EUGENE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EUGENE
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:STEIN
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4833 E MEADOWS CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8248
Mailing Address - Country:US
Mailing Address - Phone:616-288-3939
Mailing Address - Fax:888-706-7646
Practice Address - Street 1:4833 E MEADOWS CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8248
Practice Address - Country:US
Practice Address - Phone:616-288-3939
Practice Address - Fax:888-706-7646
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH216012084P0800X
GA891892084P0800X
MDD917722084P0800X
CAG535382084P0800X
ORCP2071382084P0800X
MI43010711002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3441359Medicaid
MA2604108471OtherBC/BS
MI3441359Medicaid
MA2604108471OtherBC/BS