Provider Demographics
NPI:1669594974
Name:MURRAY, MARK GARRY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GARRY
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1513 LAKELAND DR STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4829
Mailing Address - Country:US
Mailing Address - Phone:601-354-4836
Mailing Address - Fax:
Practice Address - Street 1:3200 MALLETT RD STE D3
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-9305
Practice Address - Country:US
Practice Address - Phone:228-392-6875
Practice Address - Fax:228-392-6877
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21988174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist