MEDICARE: DR. WALTER KEITH MURPHY DDS

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)	0401006869	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114447	OTHER	VA	CIGNA
2	092570	OTHER	VA	ANTHEM
3	685591	OTHER	VA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1417951344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER KEITH MURPHY DDS

Provider Business Mailing Address
First Line	:	7009 LEE PARK ROAD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3557
Country	:	US
Telephone Number	:	804-746-1864
Fax Number	:	804-746-4158

Provider Business Practice Location Address
First Line	:	7009 LEE PARK ROAD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3557
Country	:	US
Telephone Number	:	804-746-1864
Fax Number	:	804-746-4158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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