Basic Information
| Provider Information | |||||||||
| NPI: | 1578544755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | TIMOTHY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 618 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949480618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154933350 | ||||||||
| FaxNumber: | 4154933301 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 ROWLAND WAY | ||||||||
| Address2: | STE 215 | ||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949455038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158975171 | ||||||||
| FaxNumber: | 4158921611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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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 | 207Q00000X | G36133 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BM3162120 | 01 | CA | FEDERAL DEA LICENSE | OTHER | G36133 | 01 | CA | STATE LICENSE | OTHER |