Healthcare Provider Details

I. General information

NPI: 1801890256
Provider Name (Legal Business Name): AHMAD H MURAYWID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 S CLARK ST SUITE A
MEXICO MO
65265-4104
US

IV. Provider business mailing address

3626 S CLARK ST SUITE A
MEXICO MO
65265-4104
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-7366
  • Fax: 573-581-7422
Mailing address:
  • Phone: 573-581-7366
  • Fax: 573-581-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR8158
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: