Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 036.141932 | IL |
NPI | 1073927612 |
---|---|
Provider Name | Thomas Murphy |
First Address | Carbondale, IL 62901-1474 |
Second Address | Carbondale, IL 62901-1474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2014 |
Last Update Date | 04/07/2017 |