Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 40884 | MT |
N | 213EP1101X | Primary Podiatric Medicine | POD.0000763 | CO |
N | 213ES0103X | Foot & Ankle Surgery | POD.0000763 | CO |
NPI | 1326305509 |
---|---|
Provider Name | Keith Layne Murdock |
First Address | Billings, MT 59102-7531 |
Second Address | Billings, MT 59102-7531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 14/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01776223 | (05) | CO |