=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811150667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN M MURPHY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2008
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3580 W 9000 S
-----------------------------------------------------
City | WEST JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84088-8812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-703-0014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1847
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85299-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-507-2961
-----------------------------------------------------
Fax | 480-507-2971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SOLE OWNER
-----------------------------------------------------
Name | RYAN M MURPHY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 480-507-2961
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 333411-1205/8905
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------