MEDICARE: MURPHY MAXILLOFACIAL SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1396139051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURPHY MAXILLOFACIAL SURGERY

Provider Business Mailing Address
First Line	:	1136 E STUART ST STE 3240
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1196
Country	:	US
Telephone Number	:	970-420-6848
Fax Number	:	970-682-2183

Provider Business Practice Location Address
First Line	:	1136 E STUART ST STE 3240
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1196
Country	:	US
Telephone Number	:	970-420-6848
Fax Number	:	970-682-2183

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ALLISON BABEL
Credential	:
Telephone Number	:	970-420-6848

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	03/20/2015

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