Provider Demographics
NPI:1063675197
Name:MURDOCH, NATHAN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WILLIAM
Last Name:MURDOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1725
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-1725
Mailing Address - Country:US
Mailing Address - Phone:308-398-6400
Mailing Address - Fax:308-398-6408
Practice Address - Street 1:3610 RICHMOND CIR STE 100
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3910
Practice Address - Country:US
Practice Address - Phone:308-398-6400
Practice Address - Fax:308-398-6408
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25337207R00000X, 2085R0202X
MN1070502085R0202X
MN570122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400098083Medicare PIN