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Individual
LAURA MURPHY FERTAK
Active
Individual
LAURA MURPHY FERTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00454
TX
363AS0400X
Surgical Physician Assistant
PA00454
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1982604658
BLUE CROSS BLUE SHIELD
TX
05
—
331502001
—
TX
05
—
331502002
—
TX
01
—
601771109
US DEPT OF LABOR
—
01
—
616771101
US DEPT OF LABOR
—
01
—
616771105
US DEPT OF LABOR
—
01
—
616771110
US DEPT OF LABOR
—
01
—
86N043
BCBSTX
—
01
—
8Y0159
BCBS
TX
01
—
P00369474
MEDICARE RAILROAD
TX
01
—
P01170506
RR MEDICARE
TX
Enumeration date
07/26/2005
Last updated
02/17/2017
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