Healthcare Provider Details

I. General information

NPI: 1790956720
Provider Name (Legal Business Name): R. SCOTT MURPHY, DDS, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 1ST AVE SUITE 104
HUNTINGTON WV
25702-1236
US

IV. Provider business mailing address

2828 1ST AVE SUITE 104
HUNTINGTON WV
25702-1236
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-3200
  • Fax: 304-522-3401
Mailing address:
  • Phone: 304-522-3200
  • Fax: 304-522-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3284
License Number StateWV

VIII. Authorized Official

Name: DR. R. SCOTT MURPHY
Title or Position: PRESIDENT/OWNER
Credential: DDS, MD
Phone: 304-522-3200