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NPI Code Detail

MEDICARE: MADISON MURDOCH

MEDICARE: MADISON MURDOCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA-2098ID

General Provider Information

NPI Number : 1417626706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON MURDOCH
Provider Business Mailing Address
First Line : 3820 CRESTWOOD LN STE 2
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-4979
Country : US
Telephone Number : 208-552-7700
Fax Number :
Provider Business Practice Location Address
First Line : 3820 CRESTWOOD LN STE 2
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-4979
Country : US
Telephone Number : 208-552-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2021
Last Update Date : 03/04/2026

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Directions to “ MADISON MURDOCH ” Practice Location

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