Provider Demographics
NPI:1740365857
Name:MCMURTRY, JOHN MARK (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:MCMURTRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3315 BERRYWOOD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6571
Mailing Address - Country:US
Mailing Address - Phone:573-499-0999
Mailing Address - Fax:573-442-7120
Practice Address - Street 1:3315 BERRYWOOD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6571
Practice Address - Country:US
Practice Address - Phone:573-499-0999
Practice Address - Fax:573-442-7120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD047591L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD047591LOtherPA MD NUMBER
PA1516977Medicaid
PAMD047591LOtherPA MD NUMBER
PAMC630324Medicare ID - Type Unspecified