Provider Demographics
NPI:1447238506
Name:MURPHY, WALTER S (DPM)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:S
Last Name:MURPHY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WINCHUCK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9363
Mailing Address - Country:US
Mailing Address - Phone:541-412-9900
Mailing Address - Fax:541-412-9900
Practice Address - Street 1:30 WINCHUCK RIVER RD
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9363
Practice Address - Country:US
Practice Address - Phone:541-412-9900
Practice Address - Fax:541-412-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00133213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS006766OtherPTAN
KS006766OtherPTAN
KST43856Medicare UPIN
KST43856Medicare UPIN
KS006766Medicare ID - Type Unspecified
KS3396750001Medicare NSC