Provider Demographics
NPI:1588689681
Name:MURRAY, EDWARD L (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:MURRAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1112
Mailing Address - Country:US
Mailing Address - Phone:570-253-1540
Mailing Address - Fax:570-253-4278
Practice Address - Street 1:304 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1112
Practice Address - Country:US
Practice Address - Phone:570-253-1540
Practice Address - Fax:570-253-4278
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-001922-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4922490001OtherMEDICARE DME PTAN
PA0005078870002Medicaid
0583206OtherUS HEALTHCARE
PA20709OtherBLUE SHIELD
PA077928OtherFIRST PRIORITY
T27088Medicare UPIN
0583206OtherUS HEALTHCARE