Provider Demographics
NPI:1801960687
Name:HALLEGERE MURTHY MD PA
Entity type:Organization
Organization Name:HALLEGERE MURTHY MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HALLEGERE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-274-6161
Mailing Address - Street 1:8600 SW 92ND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7397
Mailing Address - Country:US
Mailing Address - Phone:305-274-6161
Mailing Address - Fax:305-279-8899
Practice Address - Street 1:8600 SW 92ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7397
Practice Address - Country:US
Practice Address - Phone:305-274-6161
Practice Address - Fax:305-279-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38014207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95657Medicare UPIN