Basic Information
| Provider Information | |||||||||
| NPI: | 1215982996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | DIANE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 LAKE WORTH RD | ||||||||
| Address2: | #204 MEDICAL SPECIALISTS OF THE PLAM BEACHES | ||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619687968 | ||||||||
| FaxNumber: | 5619644603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1490 FOREST HILL BLVD | ||||||||
| Address2: | MEDICAL SPECIALISTS OF THE PALM BEACHES | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619675350 | ||||||||
| FaxNumber: | 5619679224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA3359 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.