Provider Demographics
NPI:1215533211
Name:MURPHY, THOMAS MATTHEW (STUDENT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MATTHEW
Last Name:MURPHY
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:MATTHEW
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10317 HOLDER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2512
Mailing Address - Country:US
Mailing Address - Phone:856-343-5780
Mailing Address - Fax:
Practice Address - Street 1:10317 HOLDER WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2512
Practice Address - Country:US
Practice Address - Phone:856-343-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program