Individual
MICHAEL RAY MYRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9300 VALLEY CHILDRENS PL, MADERA, CA 93638-8761
(559) 485-8330
(559) 485-6694
Mailing address
PO BOX 4437, FRESNO, CA 93744-4437
(559) 485-8330
(559) 485-6994
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
G38925
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G389250
—
CA
Enumeration date
05/20/2006
Last updated
09/12/2009
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