Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 03155 | IA |
NPI | 1013267491 |
---|---|
Provider Name | Shawn Michael Murphy |
First Address | Maquoketa, IA 52060-2163 |
Second Address | Maquoketa, IA 52060-2163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 13/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03155 | STATE LICENSE (01) | IA |