Healthcare Provider Details

I. General information

NPI: 1073927612
Provider Name (Legal Business Name): THOMAS L MURPHY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 TRINITY LN STE 111
BLOOMINGTON IL
61704-8112
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-6414
  • Fax: 309-661-4666
Mailing address:
  • Phone: 217-838-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036141932
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036141932
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: