Provider Demographics
NPI:1205472693
Name:MURPHY, KEVIN EDWARD (SOIDC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:EDWARD
Last Name:MURPHY
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR612 EVERETT CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0073
Mailing Address - Country:US
Mailing Address - Phone:910-440-1941
Mailing Address - Fax:
Practice Address - Street 1:RR612 EVERETT CREEK ROAD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0073
Practice Address - Country:US
Practice Address - Phone:910-440-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians