Basic Information
Provider Information | |||||||||
NPI: | 1487764890 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MURPHY | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 144333 | ||||||||
Address2: |   | ||||||||
City: | ORLANDO | ||||||||
State: | FL | ||||||||
PostalCode: | 328144333 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4074229831 | ||||||||
FaxNumber: | 4072061767 | ||||||||
Practice Location | |||||||||
Address1: | 211 S 3RD ST | ||||||||
Address2: |   | ||||||||
City: | BELLEVILLE | ||||||||
State: | IL | ||||||||
PostalCode: | 622201915 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6182342120 | ||||||||
FaxNumber: | 6182224630 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2006 | ||||||||
LastUpdateDate: | 04/16/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 036099524 | IL | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0213X | 036099524 | IL | N |   | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology |
ID Information
ID | Type | State | Issuer | Description | 200886160 | 05 | IN |   | MEDICAID | 1100112 | 01 |   | UHC MEDICARE COMPLETE | OTHER | H20423 | 01 |   | MERCY HEALTH PLAN | OTHER | 036099524 | 05 | IL |   | MEDICAID | 220030932 | 01 |   | RAILROAD MEDICARE | OTHER | 238230 | 01 | IL | HARMONY HEALTH | OTHER | 5811655 | 01 |   | AETNA | OTHER |