Provider Demographics
NPI:1720011166
Name:RANCHO MIRAGE FAMILY GROUP INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RANCHO MIRAGE FAMILY GROUP INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-773-3379
Mailing Address - Street 1:39300 BOB HOPE DRIVE
Mailing Address - Street 2:BANNAN BLDG., STE, 1105
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3203
Mailing Address - Country:US
Mailing Address - Phone:760-773-3379
Mailing Address - Fax:760-568-3679
Practice Address - Street 1:39300 BOB HOPE DRIVE
Practice Address - Street 2:BANNAN BLDG., STE, 1105
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3203
Practice Address - Country:US
Practice Address - Phone:760-773-3379
Practice Address - Fax:760-568-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080158581OtherRAILROAD MEDICARE
CAZZZ01311ZOtherBLUE SHIELD OF CA
CAZZZ21403ZOtherMEDICARE
CA1720011166OtherGROUP NPI