Provider Demographics
NPI:1043214406
Name:DE ASIS, MYRNA CATALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:CATALAN
Last Name:DE ASIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4710
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0710
Mailing Address - Country:US
Mailing Address - Phone:940-763-8077
Mailing Address - Fax:940-763-8078
Practice Address - Street 1:1819 TENTH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5012
Practice Address - Country:US
Practice Address - Phone:940-763-8077
Practice Address - Fax:940-763-8078
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK4405OtherMEDICAL LICENSE NUMBER
TXK4405OtherMEDICAL LICENSE NUMBER
TXG59862Medicare UPIN