MEDICARE: MYRIAH WILLBORN D.O.

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	207Q00000X	Family Medicine Physician	P1715	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P02601790	OTHER	TX	MCRR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740557552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAH WILLBORN D.O.

Provider Business Mailing Address
First Line	:	2406 HUNTER RD
Second Line	:	SUITE 106
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-5255
Country	:	US
Telephone Number	:	512-396-7686
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 HUNTER RD
Second Line	:	SUITE 106
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-5255
Country	:	US
Telephone Number	:	512-396-7686
Fax Number	:

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	08/11/2025

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