Provider Demographics
NPI:1902841604
Name:WILLOCK, MURRAY S (MD)
Entity Type:Individual
Prefix:
First Name:MURRAY
Middle Name:S
Last Name:WILLOCK
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:304-675-4498
Mailing Address - Fax:304-675-2103
Practice Address - Street 1:2605 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1615
Practice Address - Country:US
Practice Address - Phone:304-675-4498
Practice Address - Fax:304-675-8182
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-1929207Q00000X
WV15281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000007060OtherANTHEM BCBS
OH310917085127OtherCARESOURCE MEDICAID
OH000000181972OtherUNISON MEDICAID
001714088OtherMOUNTAIN STATE BCBS
WV0049170000Medicaid
OH0209876OtherMOLINA MEDICAID
080040491OtherRR MEDICARE
OH0209876OtherMOLINA MEDICAID
OH0379323Medicare PIN
WV0049170000Medicaid