Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 12297 | HI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 2009018473 | MO |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 99022637 | IN |
NPI | 1093813875 |
---|---|
Provider Name | Kevin D Murray |
First Address | Columbia, MO 65205-7687 |
Second Address | Jefferson City, MO 65101-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 19/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A16550 | (02) |