Provider Demographics
NPI:1770071417
Name:AHMED, MYRA
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 N STATE HIGHWAY 360 STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-6402
Mailing Address - Country:US
Mailing Address - Phone:972-606-8300
Mailing Address - Fax:972-606-4940
Practice Address - Street 1:2740 N STATE HIGHWAY 360 STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-6402
Practice Address - Country:US
Practice Address - Phone:972-606-8300
Practice Address - Fax:972-606-4940
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS8413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program