Healthcare Provider Details

I. General information

NPI: 1427097237
Provider Name (Legal Business Name): MARY A MURRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

295 CHIPETA WAY PEDS ADMIN
SALT LAKE CITY UT
84108-1220
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-3922
  • Fax: 801-587-3997
Mailing address:
  • Phone: 801-587-7400
  • Fax: 801-587-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number172266-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number172266-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5086039-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number5086039-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: