Provider Demographics
NPI:1770539710
Name:MURDOCK, EUGENE J JR (CRNA)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:J
Last Name:MURDOCK
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28068
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-8068
Mailing Address - Country:US
Mailing Address - Phone:877-899-1033
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:RM 2144
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3873
Practice Address - Fax:706-721-7763
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN051238367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA339448OtherWELLCARE CMO
GA000556817DMedicaid
GA550789920OtherTRICARE
SCGAN161Medicaid
GA000556817CMedicaid
GA430079465OtherRRMEDICARE
GA000556817CMedicaid
GA550789920OtherTRICARE