Provider Demographics
NPI:1366674699
Name:COLLEEN M. MURPHY, MD, FACOG, CORP
Entity Type:Organization
Organization Name:COLLEEN M. MURPHY, MD, FACOG, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-770-5432
Mailing Address - Street 1:4100 LAKE OTIS PKWY STE 330
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5232
Mailing Address - Country:US
Mailing Address - Phone:907-770-5432
Mailing Address - Fax:907-770-5431
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 330
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5232
Practice Address - Country:US
Practice Address - Phone:907-770-5432
Practice Address - Fax:907-770-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3162261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK3162Medicaid
AKHO7392Medicare UPIN
AK151138Medicare PIN