Provider Demographics
NPI:1750810248
Name:MURRAY, TROY TERRELL JR
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:TERRELL
Last Name:MURRAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 MIDLOTHIAN TURNPIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:N. CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5291
Mailing Address - Country:US
Mailing Address - Phone:804-461-8235
Mailing Address - Fax:804-447-3419
Practice Address - Street 1:8014 MIDLOTHIAN TURNPIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:N. CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-461-8235
Practice Address - Fax:804-447-3419
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA64235886172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA81-5264772OtherTAX ID