Provider Demographics
NPI:1023001286
Name:MURPHY, GERALD L (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 RED TAIL WAY
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7232
Mailing Address - Country:US
Mailing Address - Phone:805-527-8055
Mailing Address - Fax:805-520-8849
Practice Address - Street 1:1147 RED TAIL WAY
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7232
Practice Address - Country:US
Practice Address - Phone:805-527-8055
Practice Address - Fax:805-520-8849
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADDC375001Medicaid
CAWC37500FMedicare ID - Type Unspecified
CADDC375001Medicaid