Provider Demographics
NPI:1043071616
Name:MURRAY, JIMMY TYLER
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:TYLER
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 1:23701 S 655 RD
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-6317
Mailing Address - Country:US
Mailing Address - Phone:918-787-5452
Mailing Address - Fax:
Practice Address - Street 1:23701 S 655 RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-6317
Practice Address - Country:US
Practice Address - Phone:918-787-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist