Healthcare Provider Details

I. General information

NPI: 1801971908
Provider Name (Legal Business Name): MURPHY S MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 LAKELAND DRIVE SUITE 200
JACKSON MS
39216
US

IV. Provider business mailing address

PO BOX 55669
JACKSON MS
39296-5669
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-1610
  • Fax: 601-366-2887
Mailing address:
  • Phone: 601-981-1610
  • Fax: 601-366-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number13968
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: