Provider Demographics
NPI:1700896719
Name:MURRAY, KERMIT A (MD)
Entity type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:A
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-760-8972
Mailing Address - Fax:520-760-3417
Practice Address - Street 1:8826 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9607
Practice Address - Country:US
Practice Address - Phone:520-760-8972
Practice Address - Fax:520-760-3417
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ402095Medicaid
AZZ127581Medicare PIN
AZ4919Medicare UPIN