Douglas C Murdock, MD
Individual provider Active NPI Emergency Medicine Physician · Provo, UT
NPI 1194723320 · NPPES record last updated Jul 6, 2010
Key facts
- NPI
- 1194723320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 1959571205 (UT)
- Practice address
- 280 West Riverpark Dr
Suite 120
Provo, UT 84604 - Phone
- (801) 229-2011
- Fax
- (801) 224-0242
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031215000855 | UT | Practitioner - Emergency Medicine | 6305741661 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1959571205 | UT | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Utah Valley Radiology Associates Inc | Current |
Accepting new patients | |
| Utah Valley Emergency Physicians Inc | Emergency Medicine | Current |
Accepting new patients |
| Ihc Health Services, Inc. | Past | Accepting new patients |
Locations
331 N 400 W
Orem, UT 84057
Phone (801) 224-4080
1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119
280 River Park Dr
Ste 120
Provo, UT 84604
Phone (601) 229-2011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 1959571205 | UT | Yes |
Addresses
Primary practice location
280 West Riverpark Dr
Suite 120
Provo, UT 84604
Mailing address
280 West Riverpark Dr
Suite 120
Provo, UT 84604
Phone (801) 229-2011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D2192 | Medicaid | UT | |
| 000057844 | Other | UT | MEDICARE |
| 930056412 | Other | UT | RAILROAD MEDICARE |
Other providers in Provo, UT
- Ulf Muntzing
- Grant Lee Murdoch
- Joshua Matthew Murdoch
- Amber Caroline Murdock
- Brent John Murdock
- Laraine Murdock
- Lyndsays Nicole Murdock
- Steve Murdock
- Kaycee Murphy
- Brad Lynn Murray
All providers in Provo, UT · Emergency Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.