Basic Information
| Provider Information | |||||||||
| NPI: | 1538484472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURILLO | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | DAX | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 12TH ST | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044877726 | ||||||||
| FaxNumber: | 3045315263 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 18TH ST STE 606 | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044244575 | ||||||||
| FaxNumber: | 3044244577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2010 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2652 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2652 | WV | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.