Healthcare Provider Details

I. General information

NPI: 1568695559
Provider Name (Legal Business Name): WOM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 111TH AVE N
NAPLES FL
34108-1869
US

IV. Provider business mailing address

870 111TH AVE N
NAPLES FL
34108-1869
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-6606
  • Fax:
Mailing address:
  • Phone: 239-596-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME63528
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM OWNE MURTAGH JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-596-6606