Provider Demographics
NPI:1124025655
Name:DOVE, MYRA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:C
Last Name:DOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 FERNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4404
Mailing Address - Country:US
Mailing Address - Phone:336-402-7339
Mailing Address - Fax:
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-228-7688
Practice Address - Fax:907-228-8468
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700825207V00000X
MEMD24630207VX0000X
AK183932207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910699Medicaid
VA006210759Medicaid
NCG57649Medicare UPIN
VA006210759Medicaid