Provider Demographics
NPI:1164499570
Name:MURRAY, GREGORY R (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:MURRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1559
Mailing Address - Country:US
Mailing Address - Phone:800-274-8387
Mailing Address - Fax:814-336-4255
Practice Address - Street 1:16954 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3738
Practice Address - Country:US
Practice Address - Phone:866-962-3210
Practice Address - Fax:814-336-4255
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2109453Medicaid
G89193Medicare UPIN
OH0867125Medicare ID - Type Unspecified