Provider Demographics
NPI:1467459750
Name:MCMURTREY, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:MCMURTREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4284
Mailing Address - Fax:317-865-8355
Practice Address - Street 1:11161 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8564
Practice Address - Country:US
Practice Address - Phone:219-662-9424
Practice Address - Fax:219-662-7465
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01053168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200386920Medicaid
IN000000722505OtherANTHEM TRADITIONAL
INH68253Medicare UPIN
IN200386920Medicaid
IN202790DDMedicare PIN