Healthcare Provider Details

I. General information

NPI: 1790286136
Provider Name (Legal Business Name): DEVON MITCHELL MYERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 DOUGHERTY FERRY RD STE 100A
SAINT LOUIS MO
63122-3356
US

IV. Provider business mailing address

2325 DOUGHERTY FERRY RD STE 100A
SAINT LOUIS MO
63122-3356
US

V. Phone/Fax

Practice location:
  • Phone: 314-909-1359
  • Fax: 314-909-1370
Mailing address:
  • Phone: 314-909-1359
  • Fax: 314-909-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2023005977
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: