Basic Information
Provider Information
NPI: 1407198161
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MURRAY
FirstName: BRINKMAN
MiddleName: ALLEN
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3515 MASSILLON RD STE 300
Address2:  
City: UNIONTOWN
State: OH
PostalCode: 446857854
CountryCode: US
TelephoneNumber: 3308999350
FaxNumber: 3306341329
Practice Location
Address1: 251 LEATHERMAN RD
Address2:  
City: WADSWORTH
State: OH
PostalCode: 44281
CountryCode: US
TelephoneNumber: 3303346229
FaxNumber: 3303346110
Other Information
ProviderEnumerationDate: 03/20/2013
LastUpdateDate: 07/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X34.011638OHY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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