Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 97-00825 | NC |
N | 207VX0000X | Obstetrician | MD24630 | ME |
NPI | 1124025655 |
---|---|
Provider Name | Dr. Myra C Dove |
First Address | Mooresville, NC 28117-4404 |
Second Address | Damariscotta, ME 04543-4067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006210759 | (05) | VA |
8910699 | (05) | NC |
G57649 | (02) | NC |