Provider Demographics
NPI:1982613683
Name:STOKES, MYRON CORNEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:CORNEL
Last Name:STOKES
Suffix:
Gender:M
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 1562
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1562
Mailing Address - Country:US
Mailing Address - Phone:901-316-5648
Mailing Address - Fax:901-221-8070
Practice Address - Street 1:1143 CULLY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8502
Practice Address - Country:US
Practice Address - Phone:615-484-8128
Practice Address - Fax:901-328-5599
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21733207QA0505X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4212217OtherMEDICARE ADVANTAGE
TN1510428Medicaid
TN5108599OtherCIGNA
TN01262457OtherAMERIGROUP
TN20350091323OtherAMERICHOICE
TN4212217OtherBCBS TN
TN38199331Medicare PIN