Healthcare Provider Details

I. General information

NPI: 1659342285
Provider Name (Legal Business Name): CARL MACK MYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 RUNNING HORSE ROAD
PLATTE CITY MO
64079-9761
US

IV. Provider business mailing address

9411 N OAK TRFY SUITE LL1
KANSAS CITY MO
64155-2262
US

V. Phone/Fax

Practice location:
  • Phone: 816-858-2200
  • Fax: 816-858-3611
Mailing address:
  • Phone: 816-436-7072
  • Fax: 816-436-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35257
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: