Healthcare Provider Details

I. General information

NPI: 1972865269
Provider Name (Legal Business Name): MURPHY MAXILLOFACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STUART ST SUITE 3-240
FORT COLLINS CO
80525-1195
US

IV. Provider business mailing address

1136 E STUART ST SUITE 3-240
FORT COLLINS CO
80525-1195
US

V. Phone/Fax

Practice location:
  • Phone: 970-420-6848
  • Fax: 970-682-2183
Mailing address:
  • Phone: 970-420-6848
  • Fax: 970-682-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10154
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number51252
License Number StateCO

VIII. Authorized Official

Name: DR. ARIC A MURPHY
Title or Position: CEO, SURGEON
Credential: DDS, MD
Phone: 970-420-6848