Provider Demographics
NPI:1316152911
Name:MURTHY, RAGUVEER (MD)
Entity type:Individual
Prefix:DR
First Name:RAGUVEER
Middle Name:
Last Name:MURTHY
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 1:15496 MAX LEGGETT PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2564
Mailing Address - Country:US
Mailing Address - Phone:904-895-5400
Mailing Address - Fax:904-895-5401
Practice Address - Street 1:15496 MAX LEGGETT PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2564
Practice Address - Country:US
Practice Address - Phone:904-895-5400
Practice Address - Fax:904-895-5401
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107642207RC0000X, 207RI0011X, 207R00000X
VA0101253170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1316152911Medicaid
IL036125558Medicaid
MO1316152911Medicaid