Basic Information
| Provider Information | |||||||||
| NPI: | 1538190186 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MURDOCK FAMILY MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19531 COCHRAN BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339482081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412553535 | ||||||||
| FaxNumber: | 9417432121 | ||||||||
| Practice Location | |||||||||
| Address1: | 19531 COCHRAN BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339482081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412553535 | ||||||||
| FaxNumber: | 9417432121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | KENNEDY | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9412553535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.