Provider Demographics
NPI:1205802238
Name:MURRY, PAUL J (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:MURRY
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:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6461
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:221 W 21ST ST
Practice Address - Street 2:STE 1
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-4754
Practice Address - Country:US
Practice Address - Phone:440-233-0138
Practice Address - Fax:440-233-1051
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065709207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3025372Medicaid
OH0981700Medicaid
OH0236248Medicaid
OH0789192Medicare ID - Type Unspecified
OH9284951Medicare PIN
OH3025372Medicaid
OH0981700Medicaid