MEDICARE: DR. MARTHA ROBB HUMPHREY M.D.

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	207R00000X	Internal Medicine Physician	1638231205	UT

General Provider Information

NPI Number	:	1295065886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA ROBB HUMPHREY M.D.

Provider Business Mailing Address
First Line	:	7543 STONE RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5237
Country	:	US
Telephone Number	:	801-943-7421
Fax Number	:	801-943-3254

Provider Business Practice Location Address
First Line	:	7543 STONE RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5237
Country	:	US
Telephone Number	:	801-943-7421
Fax Number	:	801-943-3254

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

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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