Healthcare Provider Details

I. General information

NPI: 1659399921
Provider Name (Legal Business Name): MICHAEL VINCENT MURPHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA OUT PATIENT CLINIC 551 HEALTH
DAYTONA BEACH FL
32114
US

IV. Provider business mailing address

551 NATIONAL HEALTH CARE DR
DAYTONA BEACH FL
32114-1495
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7500
  • Fax: 386-323-7523
Mailing address:
  • Phone: 386-323-7523
  • Fax: 386-323-7523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number120744-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: