Basic Information
| Provider Information | |||||||||
| NPI: | 1669458147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 N CIRCLE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809091182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197764740 | ||||||||
| FaxNumber: | 7197764750 | ||||||||
| Practice Location | |||||||||
| Address1: | 3010 N CIRCLE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809091182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197764740 | ||||||||
| FaxNumber: | 7197764750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 12/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 29640 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01296409 | 05 | CO | MEDICAID | O1296409 | 05 | CO | MEDICAID |