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1124025655

NPI Code Detail

MEDICARE: DR. MYRA C DOVE MD

MEDICARE: DR. MYRA C DOVE 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	9700825	NC
2	207VX0000X	Obstetrics Physician	MD24630	ME
3	207V00000X	Obstetrics & Gynecology Physician	183932	AK

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124025655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRA C DOVE MD

Provider Business Mailing Address
First Line	:	262 FERNBROOK DR
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4404
Country	:	US
Telephone Number	:	336-402-7339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 TONGASS AVE
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5746
Country	:	US
Telephone Number	:	907-228-7688
Fax Number	:	907-228-8468

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/06/2023

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Directions to “ DR. MYRA C DOVE MD” Practice Location

Language	Start Address	Practice Location

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