Provider Demographics
NPI:1881624781
Name:L WYNETTE MURPHY MD PC
Entity type:Organization
Organization Name:L WYNETTE MURPHY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L WYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-233-7410
Mailing Address - Street 1:3725 S SAGINAW ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4321
Mailing Address - Country:US
Mailing Address - Phone:810-233-7410
Mailing Address - Fax:810-233-7420
Practice Address - Street 1:3725 S SAGINAW ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4321
Practice Address - Country:US
Practice Address - Phone:810-233-7410
Practice Address - Fax:810-233-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056342207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY NUMBER
BM4058308OtherDEA