Basic Information
| Provider Information | |||||||||
| NPI: | 1215950977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMURRY | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCMURRY | ||||||||
| OtherFirstName: | N | ||||||||
| OtherMiddleName: | KEITH | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3301 C ST | ||||||||
| Address2: | SUITE #200-E | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164476267 | ||||||||
| FaxNumber: | 9164470621 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 C ST | ||||||||
| Address2: | SUITE #200-E | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164476267 | ||||||||
| FaxNumber: | 9164470621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 05/06/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A50990 | CA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | BM155W | 01 | CA | MEDICARE PTAN | OTHER | BM155Y | 01 | CA | MEDICARE PTAN | OTHER | BM155Z | 01 | CA | MEDICARE PTAN | OTHER | BM155X | 01 | CA | MEDICARE PTAN | OTHER | BM155T | 01 | CA | MEDICARE PTAN | OTHER | BM155S | 01 | CA | MEDICARE PTAN | OTHER | 00A509900 | 05 | CA | MEDICAID | BM155U | 01 | CA | MEDICARE PTAN | OTHER | BM155V | 01 | CA | MEDICARE PTAN | OTHER |