Provider Demographics
NPI:1053765560
Name:DOE, CYRUS C-MAX (MSN, APRN)
Entity type:Individual
Prefix:
First Name:CYRUS
Middle Name:C-MAX
Last Name:DOE
Suffix:
Gender:M
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 GRANT RD
Mailing Address - Street 2:APT 5404
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4031
Mailing Address - Country:US
Mailing Address - Phone:215-666-3033
Mailing Address - Fax:
Practice Address - Street 1:11800 GRANT RD
Practice Address - Street 2:APT 5404
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4031
Practice Address - Country:US
Practice Address - Phone:215-666-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily