Provider Demographics
NPI:1063498624
Name:MURPHY, ALICIA GUAJARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:GUAJARDO
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:1204 N MOUND
Practice Address - Street 2:NACOGDOCHES MEMORIAL HOSPITAL LAB
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-462-3635
Practice Address - Fax:936-569-4615
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0610207ZP0102X
NM200078207ZP0102X
HIMD6133207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084947301Medicaid
TX129414204Medicaid
742741883OtherCHAMPUS
F11026Medicare UPIN
TX129414204Medicaid