Provider Demographics
NPI:1790006401
Name:MCMURRY CLINIC PLLC
Entity Type:Organization
Organization Name:MCMURRY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MCMURRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-338-3361
Mailing Address - Street 1:123 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-3606
Mailing Address - Country:US
Mailing Address - Phone:580-338-3361
Mailing Address - Fax:580-338-1021
Practice Address - Street 1:123 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3606
Practice Address - Country:US
Practice Address - Phone:580-338-3361
Practice Address - Fax:580-338-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty