Healthcare Provider Details

I. General information

NPI: 1013093897
Provider Name (Legal Business Name): MURRAY BRUCE FERSHTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 COLLEGE PARK DR STE #104
CONROE TX
77384
US

IV. Provider business mailing address

15 CANDLE PINE PL
THE WOODLANDS TX
77381
US

V. Phone/Fax

Practice location:
  • Phone: 936-321-5030
  • Fax: 936-271-5033
Mailing address:
  • Phone: 936-321-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ1998
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: