Healthcare Provider Details

I. General information

NPI: 1629230230
Provider Name (Legal Business Name): JONATHON B MURPHY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 6TH AVE
SAINT ALBANS WV
25177-2836
US

IV. Provider business mailing address

201 6TH AVE PO BOX 1518
SAINT ALBANS WV
25177-2836
US

V. Phone/Fax

Practice location:
  • Phone: 304-201-3600
  • Fax: 304-201-2368
Mailing address:
  • Phone: 304-201-3600
  • Fax: 304-201-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number15271
License Number StateWV

VIII. Authorized Official

Name: MR. JONATHON BRUCE MURPHY
Title or Position: PRESIDENT
Credential: MD
Phone: 304-201-3600