Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DD2210 | NM |
NPI | 1013906619 |
---|---|
Provider Name | Dr. Mary Gail Murphy |
First Address | Shiprock, NM 87420-0160 |
Second Address | Shiprock, NM 87420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 20/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40831574 | (05) | NM |
50776223 | (05) | CO |
697500 | (05) | AZ |