1790909281 NPI number — RYAN C MURDOCK MD

Table of content: RYAN C MURDOCK MD (NPI 1790909281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790909281 NPI number — RYAN C MURDOCK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURDOCK
Provider First Name:
RYAN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790909281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 BARBARA JORDAN BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723-3077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-478-8116
Provider Business Mailing Address Fax Number:
512-478-9368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 BARBARA JORDAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78723-3077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-478-8116
Provider Business Practice Location Address Fax Number:
512-478-9368
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , with the licence number:  N9917 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: N9917 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: N9917 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2841462-03 . This is a "MEDICAID CSHCN - AUSTIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2841462-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2841462-04 . This is a "MEDICAID CSHCN - REST OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2841462-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8CW713 . This is a "BCBSTX INDIVIDUAL NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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