Individual
DR. MYRNA IVELISSE GOVER HAVENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1780 OLD HIGHWAY 50 E, UNION, MO 63084
(888) 403-1071
Mailing address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(314) 448-3791
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2010036458
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145265801
—
TX
01
—
2010036458
MISSOURI STATE BOARD OF REGISTRATION
MO
Enumeration date
08/08/2006
Last updated
04/12/2024
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