Provider Demographics
NPI:1134272982
Name:MURRY, OWEN JAMES JR (FNP APRN)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:JAMES
Last Name:MURRY
Suffix:JR
Gender:M
Credentials:FNP APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3278
Mailing Address - Country:US
Mailing Address - Phone:864-224-7577
Mailing Address - Fax:864-225-5165
Practice Address - Street 1:2503 NORTH MAIN STREET
Practice Address - Street 2:ANDERSON SKIN & CANCER CLINIC PA
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3278
Practice Address - Country:US
Practice Address - Phone:864-224-7577
Practice Address - Fax:864-225-5165
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50575Medicare UPIN