Healthcare Provider Details

I. General information

NPI: 1033215462
Provider Name (Legal Business Name): MYRA BIBB DOWLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYRA BIBB-DEVOLLD PA

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR STE 130
CENTERVILLE OH
45459-4094
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-531-0195
  • Fax: 937-531-0196
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001134
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: