Provider Demographics
NPI:1104869510
Name:MURRAY, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MD
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 44008
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:
Practice Address - Street 1:4555 EMERSON ST
Practice Address - Street 2:SUITE 230
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4966
Practice Address - Country:US
Practice Address - Phone:904-633-0130
Practice Address - Fax:904-633-0131
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03610863412082S0105X, 2086S0122X
FLME 1079542086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003130076AMedicaid
IL0361086341Medicaid
FL149S8OtherBCBSFL
FL007624400Medicaid
IL7215166OtherBCBS
ILH56475Medicare UPIN
ILL98884Medicare ID - Type Unspecified
IL0361086341Medicaid