Healthcare Provider Details

I. General information

NPI: 1336609338
Provider Name (Legal Business Name): PAUL MATTHEW MCMURRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15113 S MANILLA DR
DRAPER UT
84020-5117
US

IV. Provider business mailing address

15113 S MANILLA DR
DRAPER UT
84020-5117
US

V. Phone/Fax

Practice location:
  • Phone: 607-592-4821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13494240-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: