Doctor Name: | MISS MYRA LOUISE ANDERSON |
NPI Number: | 1255474466 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | MD.06513R |
Business Practice Address: | 879 Milling Ave Luling, LA - 700704442 |
Business Phone Number: | 9857852979 |
Business Fax Number: | 9857855051 |
Mailing Address: | 40189 Pelican Point Pkwy., GONZALES |
State: | LA |
Postal Code: | 707378501 |
Phone Number: | 5044913124 |
Fax Number: | |
NPI Enumeration Date: | 02/15/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | MD.06513R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |