Provider Demographics
NPI:1770545519
Name:MURRY, TODD C (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:MURRY
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 1:7455 W WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4338
Mailing Address - Country:US
Mailing Address - Phone:702-732-3441
Mailing Address - Fax:702-938-9954
Practice Address - Street 1:7455 W WASHINGTON AVE STE 301
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4340
Practice Address - Country:US
Practice Address - Phone:877-562-5227
Practice Address - Fax:702-938-9954
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9792207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1770545519Medicaid
NV200225021Medicaid
NV220032264Medicare PIN
H41732Medicare UPIN