Provider Demographics
NPI:1720202039
Name:DOUGLAS K MURDOCK DPM PC
Entity Type:Organization
Organization Name:DOUGLAS K MURDOCK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-946-3444
Mailing Address - Street 1:780 SWIFT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3545
Mailing Address - Country:US
Mailing Address - Phone:509-946-3444
Mailing Address - Fax:
Practice Address - Street 1:780 SWIFT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3545
Practice Address - Country:US
Practice Address - Phone:509-946-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000354213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000470Medicaid
WA1000470Medicaid
4154140001Medicare NSC