Provider Demographics
NPI:1952512634
Name:MURDOCH, LOUIS LEE (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:LEE
Last Name:MURDOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:L.
Other - Middle Name:LEE
Other - Last Name:MURDOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7337
Mailing Address - Country:US
Mailing Address - Phone:541-773-3863
Mailing Address - Fax:541-618-4413
Practice Address - Street 1:19 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7337
Practice Address - Country:US
Practice Address - Phone:541-773-3863
Practice Address - Fax:541-618-4413
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD06731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227698Medicaid
ORE08270Medicare UPIN