Healthcare Provider Details

I. General information

NPI: 1710412754
Provider Name (Legal Business Name): RICHARD S MURPHY DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12472 BREAKLINES ST APT 402
CARMEL IN
46032-7659
US

IV. Provider business mailing address

12472 BREAKLINES ST APT 402
CARMEL IN
46032-7659
US

V. Phone/Fax

Practice location:
  • Phone: 317-755-9460
  • Fax:
Mailing address:
  • Phone: 317-755-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number02004126A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02004126A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number02004126A
License Number StateIN

VIII. Authorized Official

Name: DR. RICHARD S MURPHY
Title or Position: CEO
Credential: D.O.
Phone: 317-755-9460