Basic Information
| Provider Information | |||||||||
| NPI: | 1134117997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 798 | ||||||||
| Address2: | |||||||||
| City: | ELK POINT | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570250798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053563317 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 204 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ELK POINT | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570250798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053563317 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0248 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.