MEDICARE: MURTHY MUTYALA 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	207Q00000X	Family Medicine Physician	G4178	TX

General Provider Information

NPI Number	:	1033222039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MURTHY MUTYALA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 201088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77216-1088
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:	713-500-5484

Provider Business Practice Location Address
First Line	:	4755 ALDINE MAIL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-5934
Country	:	US
Telephone Number	:	281-985-7600
Fax Number	:

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/13/2007

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