Provider Demographics
NPI:1508954066
Name:MURPHY, PHYLLIS KAYE (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:KAYE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718B LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3439
Mailing Address - Country:US
Mailing Address - Phone:727-447-1229
Mailing Address - Fax:727-446-0680
Practice Address - Street 1:718B LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3439
Practice Address - Country:US
Practice Address - Phone:727-447-1229
Practice Address - Fax:727-446-0680
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54484207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22546Medicare UPIN
FL08581Medicare ID - Type Unspecified