Healthcare Provider Details

I. General information

NPI: 1578854733
Provider Name (Legal Business Name): KEVIN DANIEL HUMPHREYS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34041 US 19 N STE A
PALM HARBOR FL
34684-2648
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-0017
  • Fax: 727-786-7521
Mailing address:
  • Phone: 727-532-0002
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME119076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: