Basic Information
| Provider Information | |||||||||
| NPI: | 1396708764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMURRY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064877921 | ||||||||
| FaxNumber: | 6064396879 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064877921 | ||||||||
| FaxNumber: | 6064396879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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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 | 207V00000X | 25746 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7100051860 | 05 | KY | MEDICAID |