Healthcare Provider Details

I. General information

NPI: 1265667869
Provider Name (Legal Business Name): TRAVIS RAINEY MURPHY SR. CST/CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 SW 2ND AVE
BOYNTON BEACH FL
33426-4373
US

IV. Provider business mailing address

PO BOX 243316
BOYNTON BEACH FL
33424-3316
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-5042
  • Fax: 561-737-5045
Mailing address:
  • Phone: 561-737-5042
  • Fax: 561-737-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number246ZS0400X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: