Healthcare Provider Details

I. General information

NPI: 1164051835
Provider Name (Legal Business Name): MACKENZIE LEE WINTER MURPHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S MACADAM AVE STE 200
PORTLAND OR
97239-3827
US

IV. Provider business mailing address

5100 S MACADAM AVE STE 200
PORTLAND OR
97239-3827
US

V. Phone/Fax

Practice location:
  • Phone: 971-202-5501
  • Fax: 971-228-2983
Mailing address:
  • Phone: 971-202-5501
  • Fax: 971-228-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO229115
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: