Healthcare Provider Details

I. General information

NPI: 1336105899
Provider Name (Legal Business Name): JOHN J MURRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 TIMBER LN
SOUTH BURLINGTON VT
05403-5201
US

IV. Provider business mailing address

600 BLAIR PARK RD SUITE 190
WILLISTON VT
05495-7586
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-0521
  • Fax: 802-864-6475
Mailing address:
  • Phone: 802-860-1145
  • Fax: 802-872-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0002988
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: