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General NPI Number Information
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NPI Number | 1578208468
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Entity Type | Individual
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Provider Name | BENJAMIN MURRAY
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Gender | Male
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 760 EAST AVE BLDG 3911
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City | PENSACOLA
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State | FL
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Zip | 32508-5136
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Country | US
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Telephone | 850-452-8970
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Fax |
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Provider Business Mailing Address
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Address Line | 556 MOWBRAY ARCH
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City | NORFOLK
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State | VA
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Zip | 23507-2130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0102208120
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License Number State | VA
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