Provider Demographics
NPI:1164632170
Name:MURRAY, MITZI L (MD, MA)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:L
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 ROCKRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4515
Mailing Address - Country:US
Mailing Address - Phone:206-446-8516
Mailing Address - Fax:
Practice Address - Street 1:3905 ROCKRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4515
Practice Address - Country:US
Practice Address - Phone:206-446-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60037544207SG0203X, 207SG0201X
WAMD60037544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0273466OtherL&I
WA1164632170Medicaid
8898285Medicare PIN