Provider Demographics
NPI:1598736977
Name:MYLES, EDWARD JEFFERY (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JEFFERY
Last Name:MYLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-0229
Mailing Address - Country:US
Mailing Address - Phone:636-789-2722
Mailing Address - Fax:636-797-5900
Practice Address - Street 1:10731 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5218
Practice Address - Country:US
Practice Address - Phone:636-789-2722
Practice Address - Fax:636-797-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO125997OtherGHP
MO22389OtherBLUE CROSS BLUE SHIELD
MO9831OtherBLUECHOICE
MO16219OtherGHP
MO115070OtherHEALTHLINK
MO4573819OtherAETNA
MO125999OtherCMR
MO125999OtherCMR