MEDICARE: DR. KIRK A MURDOCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0101054116	VA
2	207W00000X	Ophthalmology Physician	9600125	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000123C79	OTHER	VA	VA MEDICARE PROVIDER #
7	180029126	OTHER	NC	RR MEDICARE PROVIDER #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	14115	OTHER	NC	PARTNERS PROVIDER #
3	61278	OTHER	NC	MEDCOST PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	11608	OTHER	NC	OPTICARE PROVIDER #
6	240691	OTHER	VA	ANTHEM BCBS PROVIDER #
8	278833	OTHER	NC	MAMSI PROVIDER #
9	4310482	OTHER	NC	AETNA PROVIDER #
10	61401	OTHER	NC	NC BCBS PROVIDER #
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164426730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK A MURDOCK MD

Provider Business Mailing Address
First Line	:	210 N MAIN ST
Second Line	:	SUITE 144
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-4003
Country	:	US
Telephone Number	:	336-992-9637
Fax Number	:	336-992-9638

Provider Business Practice Location Address
First Line	:	210 N MAIN ST
Second Line	:	SUITE 144
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-4003
Country	:	US
Telephone Number	:	336-992-9637
Fax Number	:	336-992-9638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/08/2025

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