Provider Demographics
NPI:1154379691
Name:MURRAY, TODD I (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:I
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 1:380 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9470
Mailing Address - Country:US
Mailing Address - Phone:541-997-8412
Mailing Address - Fax:541-997-9650
Practice Address - Street 1:400 9TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-7398
Practice Address - Country:US
Practice Address - Phone:541-902-6140
Practice Address - Fax:541-902-7533
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75112207P00000X
ORMD27409207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A751120Medicaid
OR006099Medicaid
ORR137912Medicare PIN
CA00A751124Medicare ID - Type Unspecified
OR006099Medicaid