Provider Demographics
NPI:1639278666
Name:COLYER, JEFFREY W (M D)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:COLYER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 NE INDEPENDENCE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2379
Mailing Address - Country:US
Mailing Address - Phone:816-525-2840
Mailing Address - Fax:816-525-2841
Practice Address - Street 1:4940B W. 137TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224
Practice Address - Country:US
Practice Address - Phone:913-232-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103151208200000X
KS0423967208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF58305Medicare UPIN
KST617679Medicare ID - Type Unspecified
MOT617679AMedicare ID - Type Unspecified