Provider Demographics
NPI:1124021779
Name:MURRAY, NANCY B (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:B
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:B
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M,D
Mailing Address - Street 1:230 PROSPECT PL
Mailing Address - Street 2:STE 260
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1987
Mailing Address - Country:US
Mailing Address - Phone:619-437-1146
Mailing Address - Fax:619-437-1912
Practice Address - Street 1:230 PROSPECT PL
Practice Address - Street 2:STE 260
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1987
Practice Address - Country:US
Practice Address - Phone:619-437-1146
Practice Address - Fax:619-437-1912
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG057715207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE83250Medicare UPIN