Provider Demographics
NPI:1194900415
Name:MURRAY, KENNETH RAY
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 GREENBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7809
Mailing Address - Country:US
Mailing Address - Phone:901-382-8962
Mailing Address - Fax:901-276-1625
Practice Address - Street 1:1375 GREENBROOK PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7809
Practice Address - Country:US
Practice Address - Phone:901-382-8962
Practice Address - Fax:901-276-1625
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver