Basic Information
| Provider Information | |||||||||
| NPI: | 1174506315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | WYNETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 SCENIC DR | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953506131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095587248 | ||||||||
| FaxNumber: | 2095588723 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W COOLIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095775005 | ||||||||
| FaxNumber: | 2095211533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 4301056342 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207V00000X | C148024 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1602503852 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 4380839 | 05 | MI | MEDICAID | G93281 | 01 | MI | HAP | OTHER | 160D410050 | 01 | MI | COMMUNITY BLUE | OTHER | 160D410050 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 34649164 | 05 | MI | MEDICAID | 01338 | 01 | MI | AETNA | OTHER | 203333 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | C5869 | 01 | MI | MCARE | OTHER | G93281 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 0982797 | 01 | MI | HEALTHPLUS | OTHER | 160D410050 | 01 | MI | BLUE CHOICE | OTHER | 160D410050 | 01 | MI | BLUE CARE NETWORK | OTHER | 203333 | 01 | MI | HEALTH ADVANTAGE | OTHER |