Healthcare Provider Details

I. General information

NPI: 1861614240
Provider Name (Legal Business Name): DR. WILLIAM H. HUMPHRIES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 EVERGREEN LN
ROANOKE VA
24018-2647
US

IV. Provider business mailing address

3200 EVERGREEN LN
ROANOKE VA
24018-2647
US

V. Phone/Fax

Practice location:
  • Phone: 540-774-1521
  • Fax: 540-772-3080
Mailing address:
  • Phone: 540-774-1521
  • Fax: 540-772-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number0101028072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: