Provider Demographics
NPI:1679767677
Name:CARREON, MYRA DREW (MD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:DREW
Last Name:CARREON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5300
Mailing Address - Country:US
Mailing Address - Phone:253-207-4850
Mailing Address - Fax:253-858-5436
Practice Address - Street 1:1708 YAKIMA AVE STE 107
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5300
Practice Address - Country:US
Practice Address - Phone:253-207-4850
Practice Address - Fax:253-858-5436
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107431207RN0300X
WAMD60672218207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072238Medicaid