MEDICARE: BAYSHORE FAMILY PRACTICE P.A.

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	207Q00000X	Family Medicine Physician	00T29R	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659372969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSHORE FAMILY PRACTICE P.A.

Provider Business Mailing Address
First Line	:	11452 SPACE CENTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3599
Country	:	US
Telephone Number	:	832-775-9800
Fax Number	:	832-775-9820

Provider Business Practice Location Address
First Line	:	11452 SPACE CENTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3599
Country	:	US
Telephone Number	:	832-775-9800
Fax Number	:	832-775-9820

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	THOMAS J. MURPHY
Credential	:	M.D.
Telephone Number	:	832-775-9800

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/19/2010

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Directions to “BAYSHORE FAMILY PRACTICE P.A. ” Practice Location

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