Healthcare Provider Details

I. General information

NPI: 1144392432
Provider Name (Legal Business Name): DENNIS VICTOR HUMPHRIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12061 SHERATON LANE
CINCINNATI OH
45246-1611
US

IV. Provider business mailing address

12061 SHERATON LANE
CINCINNATI OH
45246-1611
US

V. Phone/Fax

Practice location:
  • Phone: 513-671-3636
  • Fax: 513-671-4419
Mailing address:
  • Phone: 513-671-3636
  • Fax: 513-671-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35030301
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: