Provider Demographics
NPI:1174602023
Name:MURBACH, JACK (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:MURBACH
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 1:2722 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-5963
Mailing Address - Country:US
Mailing Address - Phone:205-497-2365
Mailing Address - Fax:
Practice Address - Street 1:16 OFFICE PARK CIR
Practice Address - Street 2:SUITE 13
Practice Address - City:MOUNTAIN BROOK
Practice Address - State:AL
Practice Address - Zip Code:35223-2559
Practice Address - Country:US
Practice Address - Phone:205-871-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL229142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry