Provider Demographics
NPI:1851710644
Name:MCMURPHY, TIMOTHY BRICE
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRICE
Last Name:MCMURPHY
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 1:4451 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9646
Mailing Address - Country:US
Mailing Address - Phone:228-424-8235
Mailing Address - Fax:
Practice Address - Street 1:2751 TIDE MARK CV
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2038
Practice Address - Country:US
Practice Address - Phone:228-424-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
LA6577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist