Provider Demographics
NPI:1962161489
Name:MURRAY, CHEVY
Entity type:Individual
Prefix:
First Name:CHEVY
Middle Name:
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 1:1201 E OLD SETTLERS BLVD APT 7103
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2442
Mailing Address - Country:US
Mailing Address - Phone:737-279-0068
Mailing Address - Fax:
Practice Address - Street 1:1201 E OLD SETTLERS BLVD APT 7103
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2442
Practice Address - Country:US
Practice Address - Phone:737-279-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47008359172A00000X
ID58646164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No164W00000XNursing Service ProvidersLicensed Practical Nurse