MEDICARE: DR. MYRON DAVID KORIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	ME29028	FL

General Provider Information

NPI Number	:	1679713069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRON DAVID KORIS M.D.

Provider Business Mailing Address
First Line	:	3055 HARBOR DR APT 1403
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2459
Country	:	US
Telephone Number	:	954-764-5343
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 N STATE ROAD 7
Second Line	:	#9
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4378
Country	:	US
Telephone Number	:	954-753-4248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	02/27/2009

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