Healthcare Provider Details

I. General information

NPI: 1902841604
Provider Name (Legal Business Name): MURRAY S. WILLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 JACKSON AVE
POINT PLEASANT WV
25550-1615
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-4498
  • Fax: 304-675-8182
Mailing address:
  • Phone: 304-675-4498
  • Fax: 304-675-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-03-1929
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15281
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: