Provider Demographics
NPI:1598731242
Name:MYERS, JOSEPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 HIGH DR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1329
Mailing Address - Country:US
Mailing Address - Phone:816-536-5789
Mailing Address - Fax:
Practice Address - Street 1:1602 N SECOND ST
Practice Address - Street 2:GOLDEN VALLEY MEMORIAL HEALTHCARE
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735
Practice Address - Country:US
Practice Address - Phone:660-885-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423781208800000X
MOR3P95208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
340007362OtherRAILROAD MEDICARE
KS100133370BMedicaid
E87867Medicare UPIN
KS057415MYMedicare PIN
MO4632766AMedicare PIN
KS4632766BMedicare PIN