Provider Demographics
NPI:1649467416
Name:MURRAY, JASON PATRICK (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PATRICK
Last Name:MURRAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W. GORE ST.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:321-841-2452
Mailing Address - Fax:321-841-4076
Practice Address - Street 1:32 W. GORE ST.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:321-841-2452
Practice Address - Fax:321-841-4076
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL293014500Medicaid
FLE4194XMedicare PIN
FLE4194WMedicare PIN
FLP07830Medicare UPIN
FLE4194VMedicare PIN
FLE4194UMedicare PIN