Provider Demographics
NPI:1679569107
Name:MURRAY, THOMAS DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DOUGLAS
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:317 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-1338
Mailing Address - Country:US
Mailing Address - Phone:740-732-7022
Mailing Address - Fax:740-732-7149
Practice Address - Street 1:317 WEST ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1338
Practice Address - Country:US
Practice Address - Phone:740-732-7022
Practice Address - Fax:740-732-7149
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37864207QA0401X
OH35-07-8057M207QA0401X
NC9700681207QA0401X
VA0101058597207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH200868933OtherCIGNA
OH000000330018OtherANTHEM
OH2204171Medicaid
OH7100213OtherAETNA
OH0105307OtherUNITED HEALTH CARE
OHD78057OtherTHE HEALTH PLAN
OH200868933OtherCIGNA
OH0105307OtherUNITED HEALTH CARE
OHMU4034203Medicare ID - Type UnspecifiedMEDICARE