Provider Demographics
NPI:1275692246
Name:MCMURRY, RUSSELL KELLY (DO)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:KELLY
Last Name:MCMURRY
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 1:123 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-3606
Mailing Address - Country:US
Mailing Address - Phone:580-338-3361
Mailing Address - Fax:580-338-1021
Practice Address - Street 1:123 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3606
Practice Address - Country:US
Practice Address - Phone:580-338-3361
Practice Address - Fax:580-338-1021
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100110000AMedicaid
OKE09832Medicare UPIN
OK100110000AMedicaid