Provider Demographics
NPI:1720025307
Name:MURPHEY, NATHANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:G
Last Name:MURPHEY
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 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-657-9354
Mailing Address - Fax:573-657-9694
Practice Address - Street 1:605C DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-9088
Practice Address - Country:US
Practice Address - Phone:573-657-9354
Practice Address - Fax:573-657-9694
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR2D45207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00472269OtherMEDICARE RAILROAD
MO080108698OtherRAILROAD MEDICARE
MO1720025307Medicaid
MO201902434Medicaid
MO201902434Medicaid
MOA11597Medicare UPIN
MO1720025307Medicaid
MOP00472269OtherMEDICARE RAILROAD