Provider Demographics
NPI:1629096201
Name:MURREY, JOHN WALTER (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WALTER
Last Name:MURREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E CAMPUS VIEW BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4647
Mailing Address - Country:US
Mailing Address - Phone:614-396-4750
Mailing Address - Fax:614-396-4742
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:STE 5360
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-340-7747
Practice Address - Fax:614-340-7742
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34002340M2085R0202X
MO345242085R0202X
SC7332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0301373Medicaid
0420776Medicare ID - Type Unspecified
A75543Medicare UPIN