Provider Demographics
NPI:1538142567
Name:MURTAGH, FREDERICK REED (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:REED
Last Name:MURTAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 ALUMNI DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9413
Mailing Address - Country:US
Mailing Address - Phone:813-972-3351
Mailing Address - Fax:813-903-9541
Practice Address - Street 1:3301 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9413
Practice Address - Country:US
Practice Address - Phone:813-972-3351
Practice Address - Fax:813-903-9541
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCERTIFICATE #299942085N0700X
FLME247192085R0202X
MO1188482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038870000Medicaid
FL038870000Medicaid
FL71105Medicare ID - Type UnspecifiedMEDICARE