Provider Demographics
NPI:1497965313
Name:MURRAY, EDWARD L III (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:MURRAY
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7439 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1603
Mailing Address - Country:US
Mailing Address - Phone:619-464-6419
Mailing Address - Fax:619-464-0898
Practice Address - Street 1:7439 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1603
Practice Address - Country:US
Practice Address - Phone:619-464-6419
Practice Address - Fax:619-464-0898
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11814103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11814Medicare ID - Type UnspecifiedMEDICARE ID