Provider Demographics
NPI:1972846483
Name:MURRAY A THALE MD A PROF CORP
Entity Type:Organization
Organization Name:MURRAY A THALE MD A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:THALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-399-0797
Mailing Address - Street 1:17868 HIGHWAY 18 SUITE 800
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1267
Mailing Address - Country:US
Mailing Address - Phone:760-399-0797
Mailing Address - Fax:
Practice Address - Street 1:17868 HIGHWAY 18 SUITE 800
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1267
Practice Address - Country:US
Practice Address - Phone:760-399-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37450207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C374500Medicaid
A36629Medicare UPIN