Provider Demographics
NPI:1326305509
Name:MURDOCK, KEITH LAYNE (DPM)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:LAYNE
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7531
Mailing Address - Country:US
Mailing Address - Phone:406-252-5444
Mailing Address - Fax:406-245-9043
Practice Address - Street 1:3990 AVENUE D
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7531
Practice Address - Country:US
Practice Address - Phone:406-252-5444
Practice Address - Fax:406-245-9043
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000763213EP1101X, 213ES0103X
MT40884213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01776223Medicaid
CO430457ZQK9Medicare PIN