Provider Demographics
NPI:1326031295
Name:MURDOCK, JAMES MATTSON (APRN, DC)
Entity type:Individual
Prefix:
First Name:JAMES MATTSON
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:APRN, DC
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN,CNP
Mailing Address - Street 1:24700 US HIGHWAY 331 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5502
Mailing Address - Country:US
Mailing Address - Phone:850-822-3468
Mailing Address - Fax:
Practice Address - Street 1:24700 US HIGHWAY 331 S STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5502
Practice Address - Country:US
Practice Address - Phone:850-822-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14489111NS0005X
FLAPRN11007065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMU0805862Medicare ID - Type Unspecified