Provider Demographics
NPI:1316050560
Name:THAL, ALYSON P (MD)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:P
Last Name:THAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2090
Mailing Address - Street 2:3841 CORRALES ROAD
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2090
Mailing Address - Country:US
Mailing Address - Phone:505-792-3065
Mailing Address - Fax:505-792-4004
Practice Address - Street 1:3841 CORRALES RD
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9311
Practice Address - Country:US
Practice Address - Phone:505-792-3065
Practice Address - Fax:505-792-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM86-346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM38687Medicaid
NM344224801Medicare PIN