Provider Demographics
NPI:1851574388
Name:MURPHY, PAUL ROGER
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ROGER
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3127
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-3127
Mailing Address - Country:US
Mailing Address - Phone:209-573-6758
Mailing Address - Fax:208-315-9558
Practice Address - Street 1:830 SCENIC DRIVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95353-3127
Practice Address - Country:US
Practice Address - Phone:209-558-7367
Practice Address - Fax:209-558-8315
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator