Provider Demographics
NPI:1043088867
Name:MURRAY, TAYVON SR
Entity Type:Individual
Prefix:
First Name:TAYVON
Middle Name:
Last Name:MURRAY
Suffix:SR
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 1:1709 W SPOFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4253
Mailing Address - Country:US
Mailing Address - Phone:509-666-7583
Mailing Address - Fax:
Practice Address - Street 1:1709 W SPOFFORD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4253
Practice Address - Country:US
Practice Address - Phone:509-666-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor