Provider Demographics
NPI:1013093897
Name:FERSHTMAN, MURRAY BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:MURRAY
Middle Name:BRUCE
Last Name:FERSHTMAN
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 1:15 CANDLE PINE PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381
Mailing Address - Country:US
Mailing Address - Phone:936-321-2195
Mailing Address - Fax:
Practice Address - Street 1:3115 COLLEGE PARK DR
Practice Address - Street 2:STE #104
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-321-5030
Practice Address - Fax:936-271-5033
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85036Medicare UPIN
8F1259Medicare ID - Type Unspecified