Provider Demographics
NPI:1023014115
Name:MURRAY, CHARLES LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEROY
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BAY LAUREL CT
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3972
Mailing Address - Country:US
Mailing Address - Phone:831-438-4707
Mailing Address - Fax:
Practice Address - Street 1:1137 JACKSON ST S
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2042
Practice Address - Country:US
Practice Address - Phone:831-438-4707
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20168207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNAM4864751OtherDEA
MNAM4864751OtherDEA