Healthcare Provider Details

I. General information

NPI: 1801027164
Provider Name (Legal Business Name): GORDON D MURPHY III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

IV. Provider business mailing address

PO BOX 8 MDI HOSPITAL
BAR HARBOR ME
04609-0008
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-5081
  • Fax: 207-288-7024
Mailing address:
  • Phone: 207-288-5081
  • Fax: 207-288-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA001167
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: