=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659374239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD E MURRAY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 MAPLE SUMMIT RD
-----------------------------------------------------
City | JERSEYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62052-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-498-7108
-----------------------------------------------------
Fax | 618-498-7919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 390 MAPLE SUMMIT RD
-----------------------------------------------------
City | JERSEYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62052-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-498-7518
-----------------------------------------------------
Fax | 618-498-3052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036090708
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------