Provider Demographics
NPI:1003115973
Name:INSTITUTE OF NEURAL REGENERATION & TISSUE ENGINEERING
Entity Type:Organization
Organization Name:INSTITUTE OF NEURAL REGENERATION & TISSUE ENGINEERING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMURTREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-646-4044
Mailing Address - Street 1:5406 W 11000 N STE 103-215
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8942
Mailing Address - Country:US
Mailing Address - Phone:650-646-4044
Mailing Address - Fax:
Practice Address - Street 1:5406 W 11000 N STE 103-215
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8942
Practice Address - Country:US
Practice Address - Phone:650-646-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49619261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch