Provider Demographics
NPI:1659370567
Name:MURRAY, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18228 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4400
Mailing Address - Country:US
Mailing Address - Phone:813-321-1786
Mailing Address - Fax:813-321-1787
Practice Address - Street 1:6500 N SOCRUM LOOP RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4179
Practice Address - Country:US
Practice Address - Phone:133-211-7868
Practice Address - Fax:813-321-1787
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2023-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME53067207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104374400Medicaid
FL650140094001OtherTRICARE
FL07297OtherBC/BS
FL083957OtherCCN
FL12240OtherSTAYWELL/HEALTHEASE
FL202095OtherAMERIGROUP
FLPRO1162OtherQUALITY HEALTH PLAN
FL0305236OtherUNITED HEALTHCARE
FL1083957OtherAVMED
FL2111282OtherAETNA
FL070008626Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FLPRO1162OtherQUALITY HEALTH P[LAN
FL202095OtherAMERIGROUP