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General NPI Number Information
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NPI Number | 1427291954
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Entity Type | Individual
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Provider Name | JERRY FRANKLIN HUMPHRIES JR. MD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 4311 SALISBURY RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6123
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Country | US
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Telephone | 904-641-6628
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Fax | 904-642-1243
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Provider Business Mailing Address
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Address Line | 2142 KEATON CHASE DR
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-7789
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Country | US
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Telephone | 678-371-3627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME112733
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License Number State | FL
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