Healthcare Provider Details

I. General information

NPI: 1639278666
Provider Name (Legal Business Name): JEFFREY W COLYER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940B W. 137TH ST
LEAWOOD KS
66224
US

IV. Provider business mailing address

2861 NE INDEPENDENCE AVE STE 201
LEES SUMMIT MO
64064-2379
US

V. Phone/Fax

Practice location:
  • Phone: 913-232-9846
  • Fax:
Mailing address:
  • Phone: 816-525-2840
  • Fax: 816-525-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number103151
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0423967
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: