Healthcare Provider Details

I. General information

NPI: 1134272982
Provider Name (Legal Business Name): OWEN JAMES MURRY JR. FNP APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 NORTH MAIN STREET ANDERSON SKIN & CANCER CLINIC PA
ANDERSON SC
29621-3278
US

IV. Provider business mailing address

2503 NORTH MAIN STREET
ANDERSON SC
29621-3278
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-7577
  • Fax: 864-225-5165
Mailing address:
  • Phone: 864-224-7577
  • Fax: 864-225-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN2504
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: