Provider Demographics
NPI:1669458147
Name:MYERS, STEVEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
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 1:3010 N CIRCLE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1182
Mailing Address - Country:US
Mailing Address - Phone:719-776-4740
Mailing Address - Fax:719-776-4750
Practice Address - Street 1:3010 N CIRCLE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1182
Practice Address - Country:US
Practice Address - Phone:719-776-4740
Practice Address - Fax:719-776-4750
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29640207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01296409Medicaid
COO1296409Medicaid
E21605Medicare UPIN
COO1296409Medicaid
S2258Medicare ID - Type Unspecified