Provider Demographics
NPI:1740973718
Name:SAWYER, MYRON
Entity type:Individual
Prefix:MR
First Name:MYRON
Middle Name:
Last Name:SAWYER
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 1:3101 N CENTRAL AVE STE 840D
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2625
Mailing Address - Country:US
Mailing Address - Phone:480-371-7853
Mailing Address - Fax:602-801-3414
Practice Address - Street 1:3101 N CENTRAL AVE STE 840D
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2625
Practice Address - Country:US
Practice Address - Phone:480-371-7853
Practice Address - Fax:602-801-3414
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC11755251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health