Provider Demographics
NPI:1184893349
Name:MYRMOE, ARLIN MONROE (MD)
Entity type:Individual
Prefix:
First Name:ARLIN
Middle Name:MONROE
Last Name:MYRMOE
Suffix:
Gender:M
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-2856
Mailing Address - Fax:605-622-2859
Practice Address - Street 1:815 1ST AVE SE
Practice Address - Street 2:SUITE E104
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4602
Practice Address - Country:US
Practice Address - Phone:605-622-5458
Practice Address - Fax:605-622-5473
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14718Medicaid
SD6001413Medicaid
SD2639OtherDAKOTACARE
255782OtherMIDLANDS CHOICE
SD4992254OtherWELLMARK BC/BS
SD4992254OtherWELLMARK BC/BS
255782OtherMIDLANDS CHOICE
ND14718Medicaid