Provider Demographics
NPI:1407593403
Name:MURRELL, JOANTHAN WALTER
Entity Type:Individual
Prefix:
First Name:JOANTHAN
Middle Name:WALTER
Last Name:MURRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2355
Mailing Address - Country:US
Mailing Address - Phone:415-910-9097
Mailing Address - Fax:
Practice Address - Street 1:1638 KIRKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2137
Practice Address - Country:US
Practice Address - Phone:415-814-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist