Provider Demographics
NPI:1992704522
Name:MURPHY, DENNIS MARK (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MARK
Last Name:MURPHY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:305 MEMORIAL MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-231-3599
Mailing Address - Fax:386-231-3544
Practice Address - Street 1:909 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2706
Practice Address - Country:US
Practice Address - Phone:706-291-2145
Practice Address - Fax:706-234-5601
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2017-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME97779207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00304257JMedicaid
GA00304257JMedicaid
D40722Medicare UPIN