Provider Demographics
NPI:1104359090
Name:MYRICK, LEILA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:MYRICK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3447
Mailing Address - Country:US
Mailing Address - Phone:432-758-5811
Mailing Address - Fax:432-758-4880
Practice Address - Street 1:209 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3447
Practice Address - Country:US
Practice Address - Phone:432-758-5811
Practice Address - Fax:432-758-4880
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine