MEDICARE: DR. OMAR MTAWEH MURAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	01061133A	IN
2	207R00000X	Internal Medicine Physician	01061133A	IN
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A115859	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598738015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR MTAWEH MURAD M.D.

Provider Business Mailing Address
First Line	:	2720 LOW COURT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-9771
Country	:	US
Telephone Number	:	707-427-4900
Fax Number	:	707-436-2511

Provider Business Practice Location Address
First Line	:	2720 LOW COURT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-9771
Country	:	US
Telephone Number	:	707-427-4900
Fax Number	:	707-436-2511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/06/2011

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