Provider Demographics
NPI:1538484472
Name:MURILLO, JEFFREY DAX (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAX
Last Name:MURILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2312
Mailing Address - Country:US
Mailing Address - Phone:304-487-7726
Mailing Address - Fax:304-531-5263
Practice Address - Street 1:600 18TH ST STE 606
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3236
Practice Address - Country:US
Practice Address - Phone:304-424-4575
Practice Address - Fax:304-424-4577
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-04
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2652207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist