| Doctor Name: | CYRUS C-MAX DOE |
| NPI Number: | 1053765560 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSN, APRN |
| License Number: | AP130826 |
| Business Practice Address: | 11800 Grant Rd Apt 5404 Cypress, TX - 774294031 |
| Business Phone Number: | 2156663033 |
| Business Fax Number: | |
| Mailing Address: | 11800 Grant Rd, Apt 5404 CYPRESS |
| State: | TX |
| Postal Code: | 774294031 |
| Phone Number: | 2156663033 |
| Fax Number: | |
| NPI Enumeration Date: | 04/20/2016 |
| NPI Last Update Date: | 04/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP130826 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |