Healthcare Provider Details

I. General information

NPI: 1174506315
Provider Name (Legal Business Name): LISA WYNETTE MURPHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W COOLIDGE AVE
MODESTO CA
95350-4447
US

IV. Provider business mailing address

830 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-5005
  • Fax: 209-521-1533
Mailing address:
  • Phone: 209-558-7248
  • Fax: 209-558-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301056342
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2018-00345
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number50015
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC148024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: