Healthcare Provider Details

I. General information

NPI: 1538142567
Provider Name (Legal Business Name): FREDERICK REED MURTAGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 ALUMNI DR
TAMPA FL
33612-9413
US

IV. Provider business mailing address

3301 ALUMNI DR
TAMPA FL
33612-9413
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-3351
  • Fax: 813-903-9541
Mailing address:
  • Phone: 813-972-3351
  • Fax: 813-903-9541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberCERTIFICATE #29994
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME24719
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number118848
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: