Provider Demographics
NPI:1417249723
Name:MURPHY, CODY JIM (ATP, CRTS)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:JIM
Last Name:MURPHY
Suffix:
Gender:M
Credentials:ATP, CRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N GLENVILLE DR STE 501
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1957
Mailing Address - Country:US
Mailing Address - Phone:972-480-0990
Mailing Address - Fax:972-480-8377
Practice Address - Street 1:1901 N GLENVILLE DR STE 501
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1957
Practice Address - Country:US
Practice Address - Phone:972-480-0990
Practice Address - Fax:972-480-8377
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219205604Medicaid
TX752408872Medicaid
TX219205603Medicaid
TX219205603Medicaid
TX1227870001Medicare NSC