Provider Demographics
NPI:1821131962
Name:MURRAY, JOHN VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2128
Mailing Address - Country:US
Mailing Address - Phone:727-345-7100
Mailing Address - Fax:727-345-7102
Practice Address - Street 1:630 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2128
Practice Address - Country:US
Practice Address - Phone:727-345-7100
Practice Address - Fax:727-345-7102
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62468OtherBCBS
FL5248684OtherCIGNA
FL62468XMedicare PIN
D65359Medicare UPIN