Provider Demographics
NPI:1477514263
Name:MURRAY, KEITH S (RPA)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:MURRAY
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6600
Mailing Address - Country:US
Mailing Address - Phone:315-637-7878
Mailing Address - Fax:315-329-7824
Practice Address - Street 1:4101 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6610
Practice Address - Country:US
Practice Address - Phone:315-637-7878
Practice Address - Fax:315-329-7824
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001246363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01276580Medicaid
NYCC6603Medicare ID - Type Unspecified
NYJ400037496Medicare PIN
NYR56751Medicare UPIN