Basic Information
| Provider Information | |||||||||
| NPI: | 1376534867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | JO | ||||||||
| MiddleName: | ANN | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | YATES | ||||||||
| OtherFirstName: | JO | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 130 N WEBER RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604401518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306465777 | ||||||||
| FaxNumber: | 6306465729 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 N WEBER RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604401518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306465777 | ||||||||
| FaxNumber: | 6306465729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.