Basic Information
| Provider Information | |||||||||
| NPI: | 1861577975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 S UNIVERSITY DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761075737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851050 | ||||||||
| FaxNumber: | 6828857572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 04/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | H9122 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 140442852 | 05 | TX | MEDICAID | 150220508 | 05 | TX | MEDICAID | 10029173 | 01 | TX | AMERIGROUP PIN | OTHER | 75235224002 | 01 | TX | PBH PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 126241210 | 05 | TX | MEDICAID | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 521739 | 01 | TX | FIRSTHEALTH PIN | OTHER | 84510S | 01 | TX | BCBSTX IND PIN | OTHER | 120073100 | 01 | TX | FIRSTCARE PIN | OTHER | 126241208 | 05 | TX | MEDICAID | 124172 | 01 | TX | SUPERIOR PIN | OTHER |