Provider Demographics
NPI:1861499287
Name:MYRICK, STEPHEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:MYRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1112 W 6TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2249
Mailing Address - Country:US
Mailing Address - Phone:785-840-9292
Mailing Address - Fax:785-840-9272
Practice Address - Street 1:1112 W 6TH ST STE 109
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2249
Practice Address - Country:US
Practice Address - Phone:785-840-9292
Practice Address - Fax:785-840-9272
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0417893208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100009280OMedicaid
KSKA1613001Medicare PIN
KS100009280OMedicaid