Provider Demographics
NPI:1871780460
Name:MURTHY, HALLEGERE (MD)
Entity type:Individual
Prefix:
First Name:HALLEGERE
Middle Name:
Last Name:MURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HALL
Other - Middle Name:
Other - Last Name:MURTHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8600 SW 92ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7377
Mailing Address - Country:US
Mailing Address - Phone:305-274-6161
Mailing Address - Fax:305-279-8899
Practice Address - Street 1:8600 SW 92ND ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7377
Practice Address - Country:US
Practice Address - Phone:305-274-6161
Practice Address - Fax:305-279-8899
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL038014207Q00000X
FLME38014207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038014OtherMEDICAL LICENSE
FL038014OtherMEDICAL LICENSE