Healthcare Provider Details

I. General information

NPI: 1639165970
Provider Name (Legal Business Name): ROBERT P HUMPHREYS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MALVERN AVE
HOT SPRINGS AR
71901-7752
US

IV. Provider business mailing address

PO BOX 22390
HOT SPRINGS AR
71903-2390
US

V. Phone/Fax

Practice location:
  • Phone: 501-321-1000
  • Fax:
Mailing address:
  • Phone: 800-235-1415
  • Fax: 913-234-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC5065
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: