Provider Demographics
NPI:1669579280
Name:MEYERS, JOHN KIMBERLEY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KIMBERLEY
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:KIM
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2219 N 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801
Mailing Address - Country:US
Mailing Address - Phone:775-777-1224
Mailing Address - Fax:775-777-3188
Practice Address - Street 1:2219 N 5TH STREET
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-777-1224
Practice Address - Fax:775-777-3188
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMD7736207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
R2425OtherANTHEM BLUE CROSS
NVVMD7736Medicare ID - Type Unspecified
R2425OtherANTHEM BLUE CROSS