=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174511158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER B MURRY D.O
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2005
-----------------------------------------------------
Last Update Date | 04/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 FOREST AVE SUITE 301
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-1884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-797-5753
-----------------------------------------------------
Fax | 207-878-1715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301C US ROUTE 1
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-396-8600
-----------------------------------------------------
Fax | 207-396-8632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | 1526
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
-----------------------------------------------------
License Number | 1526
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------