Individual
MR. JIM IRVING MYERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1018 6TH AVE, WORTHINGTON, MN 56187-2202
(507) 372-3165
Mailing address
PO BOX 5126, SIOUX FALLS, SD 57117-5126
(605) 335-1952
(605) 373-9971
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
22238
IA
2085R0202X
Diagnostic Radiology Physician
Primary
27174
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30086653
RAILROAD MEDICARE
MN
Enumeration date
08/08/2006
Last updated
02/21/2013
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