Provider Demographics
NPI:1396712972
Name:MEYER, STEPHEN LEE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:MEYER
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 1:113 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2305
Mailing Address - Country:US
Mailing Address - Phone:417-782-2190
Mailing Address - Fax:417-782-6750
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2305
Practice Address - Country:US
Practice Address - Phone:417-782-2190
Practice Address - Fax:417-782-6750
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119652208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100348210DMedicaid
MO204710610Medicaid
128615OtherMO BCBS
OK100062770BMedicaid
KS100348210BMedicaid
KS100348210DMedicaid
KS100348210BMedicaid
MO002013693Medicare PIN
OK100062770BMedicaid
KS9004186Medicare PIN
OK400522296Medicare PIN
KS130543Medicare PIN