Provider Demographics
NPI:1528052594
Name:MYLREA, JAMES MURRAY (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MURRAY
Last Name:MYLREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1421
Mailing Address - Country:US
Mailing Address - Phone:651-292-2000
Mailing Address - Fax:
Practice Address - Street 1:166 4TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1421
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA241592085R0202X
MN265982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1528052594Medicaid
MN1528052594Medicaid
IA1016790Medicaid
MN300003935Medicare PIN
MNHP63525OtherHEALTHPARTNERS
WI004656135Medicare PIN
WI32620900Medicaid
MN133092OtherUCARE
MN824669600Medicaid
MN1604154OtherMEDICA
MNE13499Medicare UPIN
MN300003934Medicare PIN
MN2443396OtherAMERICA'S PPO
MNP00327702OtherRAILROAD MEDICARE MN
MN1046958OtherPREFERRED ONE
MN300003936Medicare PIN