Provider Demographics
NPI:1033716063
Name:MURRAY, DERERK DANIEL
Entity Type:Individual
Prefix:
First Name:DERERK
Middle Name:DANIEL
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 DEE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5319
Mailing Address - Country:US
Mailing Address - Phone:907-799-9135
Mailing Address - Fax:
Practice Address - Street 1:1072 DEE LN
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-5319
Practice Address - Country:US
Practice Address - Phone:907-799-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician