Provider Demographics
NPI:1174869952
Name:MURPHY, TRACY DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DOUGLAS
Last Name:MURPHY
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 1:4619 TRINITY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-4404
Mailing Address - Country:US
Mailing Address - Phone:307-365-2192
Mailing Address - Fax:
Practice Address - Street 1:1005 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2834
Practice Address - Country:US
Practice Address - Phone:217-222-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-23
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.097469207ZP0102X
MO2022002918207ZP0102X
WY7152A207ZP0102X
SC40263207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology