Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 20168 | MN |
NPI | 1023014115 |
---|---|
Provider Name | Dr. Charles Leroy Murray |
First Address | Scotts Valley, CA 95066-3972 |
Second Address | Shakopee, MN 55379-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A95-280 | (02) | MN |
AM4864751 | DEA (01) | MN |