Provider Demographics
NPI:1184622599
Name:MYERS, DANIEL L (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
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:P.O. BOX 804
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-0804
Mailing Address - Country:US
Mailing Address - Phone:620-228-8106
Mailing Address - Fax:620-365-1233
Practice Address - Street 1:1408 EAST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-4402
Practice Address - Country:US
Practice Address - Phone:620-365-3115
Practice Address - Fax:620-365-1233
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-22246208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100161830DMedicaid
KS102503OtherBCBS
B69456Medicare UPIN
KS102503OtherBCBS