Organization
MID COUNTY OB GYN GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN TALLEY MYERS MD (MD PHYSICIAN)
(314) 395-3163
Entity
Organization
Contact information
Practice address
11652 STUDT AVE, SAINT LOUIS, MO 63141-7025
(314) 395-3163
(314) 991-5447
Mailing address
11652 STUDT AVE, SAINT LOUIS, MO 63141-7025
(314) 395-3163
(314) 991-5447
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207881301
—
MO
Enumeration date
11/28/2006
Last updated
08/18/2008
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