Provider Demographics
NPI:1245881549
Name:MYRICK, ANTHONY DAN
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAN
Last Name:MYRICK
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 1:1069 GEORGE WASHINGTON HWY N STE D
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-3559
Mailing Address - Country:US
Mailing Address - Phone:757-966-2041
Mailing Address - Fax:
Practice Address - Street 1:1069 GEORGE WASHINGTON HWY N STE D
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-3559
Practice Address - Country:US
Practice Address - Phone:757-546-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver