Provider Demographics
NPI:1790762276
Name:MURBACH, CANDACE R (DO)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:MURBACH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:R
Other - Last Name:MURBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2001 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5148
Mailing Address - Country:US
Mailing Address - Phone:904-639-2112
Mailing Address - Fax:
Practice Address - Street 1:145 SUNSET CT STE 100
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-2464
Practice Address - Country:US
Practice Address - Phone:803-739-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15904207Q00000X
CO47926207Q00000X
GA074679207Q00000X
IN02001638A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200009280Medicaid
00001416810 04OtherUNITED
GA003174857AMedicaid
IN000000111814OtherANTHEM
IN3937240013OtherMEDICARE DMEPOS
IN080130035OtherRAILROAD MEDICARE
4594619OtherAETNA
IN7127OtherPHYSICIANS HEALTH PLAN
IN3937240013OtherMEDICARE DMEPOS
IN080130035OtherRAILROAD MEDICARE
IN200009280Medicaid
IN000000111814OtherANTHEM