Provider Demographics
NPI:1619977519
Name:MURPHY, BRYAN DOUGLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DOUGLAS
Last Name:MURPHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4003 KRESGE WAY
Mailing Address - Street 2:STE 227
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-893-9575
Mailing Address - Fax:502-893-9575
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:STE. 227
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-3342
Practice Address - Fax:502-893-9575
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30454207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040007242OtherRR MEDICARE
040007242OtherRAILROAD MEDICARE
KY64304546Medicaid
000000047672OtherANTHEM BCBS
1050468OtherPASSPORT HEALTHCARE
611005772OtherCHAMPA
2523766OtherCIGNA
1000015OtherUNITED HEALTHCARE
1000015OtherUNITED HEALTHCARE
2523766OtherCIGNA