Provider Demographics
NPI:1124029509
Name:MURFIN, MARK ALDEN JR (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALDEN
Last Name:MURFIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1063 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3001
Mailing Address - Country:US
Mailing Address - Phone:618-532-4004
Mailing Address - Fax:618-532-2856
Practice Address - Street 1:1063 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3001
Practice Address - Country:US
Practice Address - Phone:618-532-4004
Practice Address - Fax:618-532-2856
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077017208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077017Medicaid
947790Medicare PIN
IL036077017Medicaid