MEDICARE: DR. GREGORY R MYRICK 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	207P00000X	Emergency Medicine Physician	23499	MS
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	MD30396	AL

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	:	1972786960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY R MYRICK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 465
Second Line	:
City	:	MILLRY
State	:	AL
Zip	:	36558-0465
Country	:	US
Telephone Number	:	251-846-3233
Fax Number	:	251-846-3224

Provider Business Practice Location Address
First Line	:	73 LONG STREET
Second Line	:
City	:	MILLRY
State	:	AL
Zip	:	36558
Country	:	US
Telephone Number	:	251-846-3233
Fax Number	:	251-846-3224

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

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	12/20/2022

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