Provider Demographics
NPI:1396041265
Name:MYRLE R GRATE CHARTERED
Entity Type:Organization
Organization Name:MYRLE R GRATE CHARTERED
Other - Org Name:NORTH FLORIDA EAR NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRATE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-878-2165
Mailing Address - Street 1:PO BOX 13808
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3808
Mailing Address - Country:US
Mailing Address - Phone:850-878-2165
Mailing Address - Fax:850-878-5348
Practice Address - Street 1:1871 PROFESSIONAL PARK CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4506
Practice Address - Country:US
Practice Address - Phone:850-878-2165
Practice Address - Fax:850-878-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14452174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057665400Medicaid
FL057665400Medicaid