Provider Demographics
NPI:1386669323
Name:MURPHY, CHARLES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PATRICK
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 1:671 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2794
Mailing Address - Country:US
Mailing Address - Phone:504-467-5900
Mailing Address - Fax:504-467-7272
Practice Address - Street 1:671 W ESPLANADE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2794
Practice Address - Country:US
Practice Address - Phone:504-467-5900
Practice Address - Fax:504-467-7272
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1367788Medicaid
LAB64423Medicare UPIN
LA1367788Medicaid