Healthcare Provider Details

I. General information

NPI: 1659592111
Provider Name (Legal Business Name): GAMMA LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 GREENWOOD DR
POPLAR BLUFF MO
63901-2430
US

IV. Provider business mailing address

1910 GREENWOOD DR
POPLAR BLUFF MO
63901-2430
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-3207
  • Fax:
Mailing address:
  • Phone: 573-785-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY W MURPHY
Title or Position: CHAIRMAN CEO
Credential:
Phone: 573-785-3207