Provider Demographics
NPI:1306011564
Name:THE MURRAY CENTER FOR VEINS AESTHETICS ANTIAGING INC
Entity Type:Organization
Organization Name:THE MURRAY CENTER FOR VEINS AESTHETICS ANTIAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:YVON
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-830-8346
Mailing Address - Street 1:7932 W SAND LAKE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7263
Mailing Address - Country:US
Mailing Address - Phone:407-830-8346
Mailing Address - Fax:407-206-1505
Practice Address - Street 1:7932 W SAND LAKE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7263
Practice Address - Country:US
Practice Address - Phone:407-830-8346
Practice Address - Fax:407-206-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32904208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57057Medicare UPIN