Healthcare Provider Details

I. General information

NPI: 1033554464
Provider Name (Legal Business Name): MARK P MURPHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 SHOUP AVE W STE B
TWIN FALLS ID
83301-5042
US

IV. Provider business mailing address

3785 N 2538 E
TWIN FALLS ID
83301
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-9100
  • Fax:
Mailing address:
  • Phone: 208-420-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMRO-1501
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: