Provider Demographics
NPI:1619068772
Name:MURDOCK, DOUGLAS K (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:K
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 SWIFT BLVD
Mailing Address - Street 2:# 100
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-946-3444
Mailing Address - Fax:509-943-0167
Practice Address - Street 1:780 SWIFT BLVD
Practice Address - Street 2:# 100
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-946-3444
Practice Address - Fax:509-943-0167
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000354213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000470Medicaid
T02368Medicare UPIN