Provider Demographics
NPI:1881856342
Name:MURRAY, MARK M (MD,PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 W 2ND PL
Mailing Address - Street 2:STE 255
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1575
Mailing Address - Country:US
Mailing Address - Phone:720-321-8040
Mailing Address - Fax:720-321-8041
Practice Address - Street 1:11750 W 2ND PL
Practice Address - Street 2:STE 255
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1575
Practice Address - Country:US
Practice Address - Phone:720-321-8040
Practice Address - Fax:720-321-8041
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN96122084N0400X
CODR.00542382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50529021Medicaid
CO50529021Medicaid
CO364201ZG43Medicare UPIN