Provider Demographics
NPI:1508988643
Name:BOURAY, MYRON LYLE
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:LYLE
Last Name:BOURAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 INWOOD VLG
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4393
Mailing Address - Country:US
Mailing Address - Phone:214-750-1613
Mailing Address - Fax:214-635-5900
Practice Address - Street 1:333 INWOOD VLG
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4393
Practice Address - Country:US
Practice Address - Phone:214-750-1613
Practice Address - Fax:214-635-5900
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20262237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter