Individual
MRS. MYRTHA BASILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
721 CLINIC DR, STE A, TYLER, TX 75701-2043
(903) 592-6152
(903) 526-0629
Mailing address
PO BOX 731912, DALLAS, TX 75373-1912
(903) 877-7777
(903) 877-7754
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
L6778
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1618910-01
—
TX
01
—
8J8440
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/17/2005
Last updated
07/18/2019
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