| NPI | 1104042035 |
|---|---|
| Former Name | MARY MYRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: TX N7610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2006-01146) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-04-15 |