Provider Demographics
NPI:1164426730
Name:MURDOCK, KIRK A (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:A
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5208
Mailing Address - Country:US
Mailing Address - Phone:828-323-8289
Mailing Address - Fax:
Practice Address - Street 1:725 HIGHLAND OAKS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7109
Practice Address - Country:US
Practice Address - Phone:336-659-8180
Practice Address - Fax:336-659-8363
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600125207W00000X
VA0101054116207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC278833OtherMAMSI PROVIDER #
NC4310482OtherAETNA PROVIDER #
VA240691OtherANTHEM BCBS PROVIDER #
VA000123C79OtherVA MEDICARE PROVIDER #
NC11608OtherOPTICARE PROVIDER #
NC61278OtherMEDCOST PROVIDER #
NC8961401Medicaid
NC180029126OtherRR MEDICARE PROVIDER #
NC61401OtherNC BCBS PROVIDER #
NC14115OtherPARTNERS PROVIDER #
VA006303382OtherVA MEDICAID PROVIDER #
NC61278OtherMEDCOST PROVIDER #
VA006303382OtherVA MEDICAID PROVIDER #
NC180029126OtherRR MEDICARE PROVIDER #