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General NPI Number Information
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NPI Number | 1396041265
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Entity Type | Organization
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Legal Business Name | MYRLE R GRATE CHARTERED
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 1871 PROFESSIONAL PARK CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4506
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Country | US
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Telephone | 850-878-2165
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Fax | 850-878-5348
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Provider Business Mailing Address
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Address Line | PO BOX 13808
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City | TALLAHASSEE
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State | FL
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Zip | 32317-3808
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Country | US
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Telephone | 850-878-2165
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Fax | 850-878-5348
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Authorized Official
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Title or Position | CEO
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Name | DR. MYRLE R GRATE JR.
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Credential | MD
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Telephone | 850-878-2165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME14452
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License Number State | FL
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