1235531930 NPI number — JEREMIAH C. MURPHY, M.D., PC

Table of content: (NPI 1235531930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235531930 NPI number — JEREMIAH C. MURPHY, M.D., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEREMIAH C. MURPHY, M.D., PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235531930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19260 SW 65TH AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
TUALATIN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97062-5701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-692-1200
Provider Business Mailing Address Fax Number:
503-692-1220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19260 SW 65TH AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
TUALATIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97062-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-692-1200
Provider Business Practice Location Address Fax Number:
503-692-1220
Provider Enumeration Date:
09/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DE LOSS
Authorized Official First Name:
FAYE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
503-692-1200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD25718 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 023195 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com