Provider Demographics
NPI:1245226463
Name:MEYER, LARRY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1531 E BRADFORD PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6566
Mailing Address - Country:US
Mailing Address - Phone:417-887-3900
Mailing Address - Fax:417-887-3221
Practice Address - Street 1:1000 JAMES F EPPS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7347
Practice Address - Country:US
Practice Address - Phone:417-334-5752
Practice Address - Fax:417-334-5765
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000162383207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0801532OtherUHC
MO508027802OtherMEDICAID GROUP
MOCJ4613OtherRAILROAD MEDICARE RURAL
MO196017OtherBCBS
MO6184967OtherCIGNA
MO000013493OtherMEDICARE GROUP
MOCJ4614OtherRURAL RAILROAD MEDICARE GROUP
MODN9083OtherRAILROAD MEDICARE RURAL GROUP
MO1245226463OtherNPI
MO205074016Medicaid
MO000013492OtherMEDICARE GROUP
MO435684OtherHEALTHLINK
MO435684OtherHEALTHLINK
MO924883493Medicare PIN
MO924883492Medicare PIN
MO6184967OtherCIGNA
MO000013493OtherMEDICARE GROUP
MO1245226463OtherNPI
MO0801532OtherUHC