Provider Demographics
NPI:1790762276
Name:MURBACH, CANDACE R (DO)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:MURBACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:R
Other - Last Name:MURBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2001 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5148
Mailing Address - Country:US
Mailing Address - Phone:904-639-2112
Mailing Address - Fax:
Practice Address - Street 1:2001 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5148
Practice Address - Country:US
Practice Address - Phone:904-639-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47926207Q00000X
GA074679207Q00000X
IN02001638A207Q00000X
FLOS15904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00001416810 04OtherUNITED
GA003174857AMedicaid
4594619OtherAETNA
IN080130035OtherRAILROAD MEDICARE
IN3937240013OtherMEDICARE DMEPOS
IN7127OtherPHYSICIANS HEALTH PLAN
IN000000111814OtherANTHEM
IN200009280Medicaid
IN3937240013OtherMEDICARE DMEPOS
IN080130035OtherRAILROAD MEDICARE
IN200009280Medicaid
IN000000111814OtherANTHEM