Basic Information
Provider Information | |||||||||
NPI: | 1184622599 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MYERS | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 804 | ||||||||
Address2: |   | ||||||||
City: | IOLA | ||||||||
State: | KS | ||||||||
PostalCode: | 667490804 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6202288106 | ||||||||
FaxNumber: | 6203651233 | ||||||||
Practice Location | |||||||||
Address1: | 1408 EAST ST | ||||||||
Address2: |   | ||||||||
City: | IOLA | ||||||||
State: | KS | ||||||||
PostalCode: | 667494402 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6203653115 | ||||||||
FaxNumber: | 6203651233 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/09/2005 | ||||||||
LastUpdateDate: | 08/03/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 04-22246 | KS | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 100161830D | 05 | KS |   | MEDICAID | 102503 | 01 | KS | BCBS | OTHER |