MEDICARE: RANDALL HUMPHREYS P A

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	207K00000X	Allergy & Immunology Physician	ME59222	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	12097	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1548372873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL HUMPHREYS P A

Provider Business Mailing Address
First Line	:	2401 SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2170
Country	:	US
Telephone Number	:	850-785-2717
Fax Number	:	850-785-2301

Provider Business Practice Location Address
First Line	:	2401 SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2170
Country	:	US
Telephone Number	:	850-785-2717
Fax Number	:	850-785-2301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDALL F HUMPHREYS
Credential	:	M.D.
Telephone Number	:	850-785-2717

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/02/2010

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Directions to “RANDALL HUMPHREYS P A ” Practice Location

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