Provider Demographics
NPI:1801971908
Name:MARTIN, MURPHY S (MD)
Entity type:Individual
Prefix:
First Name:MURPHY
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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 55669
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-5669
Mailing Address - Country:US
Mailing Address - Phone:601-981-1610
Mailing Address - Fax:601-366-2887
Practice Address - Street 1:1513 LAKELAND DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-981-1610
Practice Address - Fax:601-366-2887
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13968207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113580Medicaid
390000064Medicare ID - Type Unspecified
MS00113580Medicaid