Healthcare Provider Details

I. General information

NPI: 1336677442
Provider Name (Legal Business Name): LEIGH ANN HUMPHRIES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 ILLINOIS ST FL 6
SAN FRANCISCO CA
94158-2518
US

IV. Provider business mailing address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7475
  • Fax:
Mailing address:
  • Phone: 813-494-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA205139
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA205139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: