Healthcare Provider Details

I. General information

NPI: 1174602023
Provider Name (Legal Business Name): JACK MURBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 OFFICE PARK CIR SUITE 13
MOUNTAIN BROOK AL
35223-2559
US

IV. Provider business mailing address

2722 CHESAPEAKE DR
HUEYTOWN AL
35023-5963
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-7166
  • Fax:
Mailing address:
  • Phone: 205-497-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22914
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: