Healthcare Provider Details

I. General information

NPI: 1912983313
Provider Name (Legal Business Name): MARY C MURPHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 BROOKES TER
SAN DIEGO CA
92103-5105
US

IV. Provider business mailing address

1284 BROOKES TER
SAN DIEGO CA
92103-5105
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-3303
  • Fax: 619-297-3372
Mailing address:
  • Phone: 619-297-3303
  • Fax: 619-297-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG74754
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG074754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: