Individual
JACK EDWARD MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
800 OAK ST, SHELDON, IA 51201-1242
(712) 324-5356
(712) 324-6515
Mailing address
800 OAK ST, P.O. BOX 10, SHELDON, IA 51201-1242
(712) 324-5356
(712) 324-6515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000618
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0254656
—
IA
05
—
0638593
—
IA
Enumeration date
10/19/2006
Last updated
07/09/2007
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