Provider Demographics
NPI:1093972994
Name:TED MURRAY
Entity Type:Organization
Organization Name:TED MURRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-556-2711
Mailing Address - Street 1:4200 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2892
Mailing Address - Country:US
Mailing Address - Phone:563-556-2711
Mailing Address - Fax:
Practice Address - Street 1:4200 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2892
Practice Address - Country:US
Practice Address - Phone:563-556-2711
Practice Address - Fax:563-556-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06254261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental