MEDICARE: MURRAY A THALE MD A PROF CORP

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	207T00000X	Neurological Surgery Physician	C37450	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	:	1972846483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURRAY A THALE MD A PROF CORP

Provider Business Mailing Address
First Line	:	17868 HIGHWAY 18 SUITE 800
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-1267
Country	:	US
Telephone Number	:	760-399-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	17868 HIGHWAY 18 SUITE 800
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-1267
Country	:	US
Telephone Number	:	760-399-0797
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	MURRAY ALLEN THALE
Credential	:	M.D.
Telephone Number	:	760-399-0797

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	04/03/2013

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