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General NPI Number Information
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NPI Number | 1467496646
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Entity Type | Individual
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Provider Name | JOHN STEWART HUMPHREY MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 319 S SILVER SPRINGS RD STE C
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-6308
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Country | US
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Telephone | 573-334-4263
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Fax | 573-334-3699
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Provider Business Mailing Address
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Address Line | 319 S SILVER SPRINGS RD STE C
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-6308
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Country | US
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Telephone | 573-334-4263
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Fax | 573-334-3699
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A99381
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME95230
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2009 023 891
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License Number State | MO
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