Healthcare Provider Details

I. General information

NPI: 1194888495
Provider Name (Legal Business Name): BRIAN J MURRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DRIVE UCSD 0039
LA JOLLA CA
92093-0039
US

IV. Provider business mailing address

4285 FARLEY CT
SAN DIEGO CA
92122-3024
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-0452
  • Fax:
Mailing address:
  • Phone: 858-534-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberG 32534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: