Provider Demographics
NPI:1093791311
Name:MURRAH, CHANTEL B (DPM PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANTEL
Middle Name:B
Last Name:MURRAH
Suffix:
Gender:F
Credentials:DPM PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CHAMBERS ST 200
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4519
Mailing Address - Country:US
Mailing Address - Phone:801-627-2122
Mailing Address - Fax:801-627-2125
Practice Address - Street 1:3590 HARRISON BLVD
Practice Address - Street 2:# G1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2060
Practice Address - Country:US
Practice Address - Phone:801-627-2122
Practice Address - Fax:801-627-2125
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57311370501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU97227Medicare UPIN
UT5240980001Medicare NSC
UT005597503Medicare PIN