Provider Demographics
NPI:1386675205
Name:BRANCH, MYRTHO M (MD)
Entity Type:Individual
Prefix:
First Name:MYRTHO
Middle Name:M
Last Name:BRANCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYRTHO
Other - Middle Name:
Other - Last Name:MOMPOINT-BRANCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3709
Mailing Address - Country:US
Mailing Address - Phone:407-275-2203
Mailing Address - Fax:407-282-7012
Practice Address - Street 1:2500 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3709
Practice Address - Country:US
Practice Address - Phone:407-275-2203
Practice Address - Fax:407-282-7012
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME734322084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
46298OtherBCBS