Basic Information
| Provider Information | |||||||||
| NPI: | 1811953904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 67000 | ||||||||
| Address2: | DEPARTMENT 272801 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482672728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177823190 | ||||||||
| FaxNumber: | 5177821223 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 MONTGOMERY DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954046617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075252902 | ||||||||
| FaxNumber: | 7075252904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34748 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 34748 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 4301072911 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | G159696 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | 34748 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 104087628 | 05 | MI | MEDICAID | 290012232 | 01 | MI | RR MEDICARE | OTHER | BM5956012 | 01 | CA | FEDERAL DEA LICENSE | OTHER | G159696 | 01 | CA | STATE MEDICAL LICENSE | OTHER |