Provider Demographics
NPI:1396337440
Name:MURDAUGH, ZACHARY DEWAYNE
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DEWAYNE
Last Name:MURDAUGH
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:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:CROWDER
Mailing Address - State:OK
Mailing Address - Zip Code:74430-0506
Mailing Address - Country:US
Mailing Address - Phone:918-429-9170
Mailing Address - Fax:
Practice Address - Street 1:211 N I AVE
Practice Address - Street 2:
Practice Address - City:CROWDER
Practice Address - State:OK
Practice Address - Zip Code:74430
Practice Address - Country:US
Practice Address - Phone:918-429-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator