Provider Demographics
NPI:1477836070
Name:MAYS, MYRTIE B (MD)
Entity type:Individual
Prefix:
First Name:MYRTIE
Middle Name:B
Last Name:MAYS
Suffix:
Gender:F
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:PO BOX 2066
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46061-2066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:317-877-6808
Practice Address - Street 1:22345 SCHULLEY RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-8800
Practice Address - Country:US
Practice Address - Phone:317-877-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034179174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist