Provider Demographics
NPI:1760442008
Name:MURPHY, MARY F (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:STOVER
Mailing Address - State:MO
Mailing Address - Zip Code:65078-0040
Mailing Address - Country:US
Mailing Address - Phone:573-832-1368
Mailing Address - Fax:573-377-6102
Practice Address - Street 1:1200 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5868
Practice Address - Country:US
Practice Address - Phone:307-352-8577
Practice Address - Fax:307-875-8800
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1100692085R0202X, 2085R0202X, 2085D0003X
CO472642085B0100X, 2085D0003X, 2085U0001X, 2085N0904X, 2085P0229X
WY7908A2085B0100X, 2085R0202X, 2085D0003X, 2085U0001X, 2085P0229X, 2085N0904X
VT042.00135662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC303554Medicare PIN
COP00683118Medicare PIN
WYW25017OtherMEDICARE PTAN
MO1760442008Medicaid
MO367000002OtherMEDICARE PTAN
CO71535870Medicaid