Healthcare Provider Details

I. General information

NPI: 1992816615
Provider Name (Legal Business Name): JAMES A HUMPHREY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 STATE ROUTE 356
LEECHBURG PA
15656-2033
US

IV. Provider business mailing address

1181 STATE ROUTE 356
LEECHBURG PA
15656-2033
US

V. Phone/Fax

Practice location:
  • Phone: 724-845-1145
  • Fax: 724-845-1679
Mailing address:
  • Phone: 724-845-1145
  • Fax: 724-845-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberOS-006017L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine
License NumberOS006017L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: