Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301049090 | MI |
NPI | 1013926948 |
---|---|
Provider Name | Mark R Mcmurray |
First Address | Petoskey, MI 49770-0430 |
Second Address | Petoskey, MI 49770-8895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 05/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2592967 | (05) | MI |
E16037 | (02) | MI |