Organization
SELF PROVIDER GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M MCMURPHY PHD (PRACTICE MANAGER)
(580) 327-5442
Entity
Organization
Contact information
Practice address
410 4TH ST, STE G, ALVA, OK 73717-2372
(580) 327-5442
(580) 327-2207
Mailing address
410 4TH ST, STE G, ALVA, OK 73717-2372
(580) 327-5442
(580) 327-2207
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14793
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200045340B
—
OK
Enumeration date
05/29/2008
Last updated
05/29/2008
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