MEDICARE: DR. TIMOTHY CHARLES MURPHY D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D7928	OR

General Provider Information

NPI Number	:	1306121546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY CHARLES MURPHY D.M.D.

Provider Business Mailing Address
First Line	:	421 SW OAK ST STE 210
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97204-1842
Country	:	US
Telephone Number	:	503-988-3663
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 SW OAK ST STE 210
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97204-1842
Country	:	US
Telephone Number	:	503-988-3663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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