Healthcare Provider Details

I. General information

NPI: 1558409490
Provider Name (Legal Business Name): MURPHY GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E CLOVER ST
HARLAN KY
40831-2312
US

IV. Provider business mailing address

402 E CLOVER ST
HARLAN KY
40831-2312
US

V. Phone/Fax

Practice location:
  • Phone: 606-573-4820
  • Fax: 606-573-6128
Mailing address:
  • Phone: 606-573-3700
  • Fax: 606-573-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number17016
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: