Basic Information
| Provider Information | |||||||||
| NPI: | 1457519225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 E. DUPONT RD. | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468251545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603739728 | ||||||||
| FaxNumber: | 2604585664 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 RANDALLIA DR | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468054638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603736315 | ||||||||
| FaxNumber: | 2603736348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 10/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036-074408 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 036-074408 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 036-074408 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 2083P0901X | 036-074408 | IL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 2083T0002X | 036-074408 | IL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Medical Toxicology | 2083X0100X | 036-074408 | IL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 208D00000X | 036-074408 | IL | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 000000602075 | 01 | IN | ANTHEM | OTHER | 200929700 | 05 | IN | MEDICAID | P00732018 | 01 | IN | RAILROAD MEDICARE | OTHER |