Provider Demographics
NPI:1316360522
Name:CHANTEL B. MURRAH, DPM. PHD
Entity Type:Organization
Organization Name:CHANTEL B. MURRAH, DPM. PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:BINGHAM
Authorized Official - Last Name:MURRAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, PHD
Authorized Official - Phone:801-920-0698
Mailing Address - Street 1:5397 W 5100 S
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-9504
Mailing Address - Country:US
Mailing Address - Phone:801-920-0698
Mailing Address - Fax:
Practice Address - Street 1:3590 HARRISON BLVD
Practice Address - Street 2:#G1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2060
Practice Address - Country:US
Practice Address - Phone:801-627-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1030720501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty