Provider Demographics
NPI:1194723320
Name:MURDOCK, DOUGLAS C (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:280 WEST RIVERPARK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-229-2011
Mailing Address - Fax:801-224-0242
Practice Address - Street 1:280 WEST RIVERPARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-229-2011
Practice Address - Fax:801-224-0242
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1959571205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD2192Medicaid
UT000057844OtherMEDICARE
UT930056412OtherRAILROAD MEDICARE
UT930056412OtherRAILROAD MEDICARE
UT002330016Medicare PIN