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General NPI Number Information
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NPI Number | 1548687973
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Entity Type | Individual
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Provider Name | PERRY BLAKE MYRICK MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | PO BOX 2959
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City | ASHEVILLE
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State | NC
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Zip | 28802-2959
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Country | US
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Telephone | 828-693-0258
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 91734
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City | RICHMOND
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State | VA
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Zip | 23291-1734
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Country | US
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Telephone | 804-358-6100
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Fax | 804-342-7619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101260924
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2019-02802
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License Number State | NC
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