Healthcare Provider Details

I. General information

NPI: 1639699747
Provider Name (Legal Business Name): MYLHAN MYERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 10TH ST
ROLLA MO
65401-2905
US

IV. Provider business mailing address

604 W 6TH ST STE A
ROLLA MO
65401-2968
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-9000
  • Fax:
Mailing address:
  • Phone: 573-364-9352
  • Fax: 844-689-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number2020029485
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020029485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: