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NPI Code Detail

MEDICARE: JOHN H MYRACLE MD

MEDICARE: JOHN H MYRACLE 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
1208000000XPediatrics Physician22603NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871569046
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN H MYRACLE MD
Provider Business Mailing Address
First Line : 1701 WESTCHESTER DRIVE
Second Line : SUITE 850
City : HIGH POINT
State : NC
Zip : 27262-7254
Country : US
Telephone Number : 336-802-2536
Fax Number : 336-802-2534
Provider Business Practice Location Address
First Line : 114 KINDERTON BLVD
Second Line :
City : ADVANCE
State : NC
Zip : 27006-7302
Country : US
Telephone Number : 336-998-9742
Fax Number : 336-998-9410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 12/28/2012

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Directions to “ JOHN H MYRACLE MD” Practice Location

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