1205815123 NPI number — MR. CLEBURNE LLOYD MURDOCH RPH

Table of content: MR. CLEBURNE LLOYD MURDOCH RPH (NPI 1205815123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205815123 NPI number — MR. CLEBURNE LLOYD MURDOCH RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURDOCH
Provider First Name:
CLEBURNE
Provider Middle Name:
LLOYD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1205815123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76308-9038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-569-5333
Provider Business Mailing Address Fax Number:
940-569-5360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 70 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROTAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-735-2500
Provider Business Practice Location Address Fax Number:
325-735-3159
Provider Enumeration Date:
01/10/2006

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: 183500000X , with the licence number:  17968 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 04945 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 141693 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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