MEDICARE: MYRNA C MONREAL MD

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	207V00000X	Obstetrics & Gynecology Physician	ME37811	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962490037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRNA C MONREAL MD

Provider Business Mailing Address
First Line	:	1290 GOLFVIEW AVENUE
Second Line	:	4TH FLOOR ATTN BILLING DEPARTMENT
City	:	BARTOW
State	:	FL
Zip	:	33830-6740
Country	:	US
Telephone Number	:	863-519-7900
Fax Number	:	863-519-7696

Provider Business Practice Location Address
First Line	:	111 N 11TH ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4325
Country	:	US
Telephone Number	:	863-421-3204
Fax Number	:	863-421-3210

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	08/11/2010

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