Provider Demographics
NPI:1538401583
Name:MURDOCK, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 NW 17TH ST STE 266
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1420
Mailing Address - Country:US
Mailing Address - Phone:305-315-3377
Mailing Address - Fax:832-324-6986
Practice Address - Street 1:12750 NW 17TH ST UNIT 226
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1423
Practice Address - Country:US
Practice Address - Phone:305-315-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME153933207W00000X, 207WX0200X, 207WX0200X
TXS3027207WX0200X, 207WX0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116041700Medicaid