Provider Demographics
NPI:1174511158
Name:MURRY, CHRISTOPHER B (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:MURRY
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 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:1250 FOREST AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1884
Practice Address - Country:US
Practice Address - Phone:207-797-5753
Practice Address - Fax:207-878-1715
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1526207YX0905X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME338000099Medicaid
MEHX1691OtherMEDICARE PTAN GRP MM8648
MEAX6996OtherMEDICARE PTAN GRP 152556
ME018247OtherANTHEM
ME1044199OtherAETNA
MEG02574OtherHARVARD PILGRIM
ME338000099Medicaid
ME018247OtherANTHEM
MEMM645303Medicare PIN
MEHX1691OtherMEDICARE PTAN GRP MM8648
MEAX6996OtherMEDICARE PTAN GRP 152556