Provider Demographics
NPI:1871778001
Name:MYATT, JAMES P (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:MYATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23667
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3667
Mailing Address - Country:US
Mailing Address - Phone:254-235-9355
Mailing Address - Fax:254-235-2135
Practice Address - Street 1:321 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-235-9355
Practice Address - Fax:254-235-2135
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1791207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301258YTXVOtherMEDICARE
TX217042503Medicaid