Provider Demographics
NPI:1407096225
Name:NATHAN, MYRON L (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:L
Last Name:NATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5530
Mailing Address - Country:US
Mailing Address - Phone:310-276-3305
Mailing Address - Fax:310-276-3285
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-276-3305
Practice Address - Fax:310-276-3285
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist