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General NPI Number Information
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NPI Number | 1669680260
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Entity Type | Organization
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Legal Business Name | CHARLES R. HUMPHREY, M.D.,INC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 1415 ROSS AVE
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City | EL CENTRO
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State | CA
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Zip | 92243-4306
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Country | US
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Telephone | 760-355-2207
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Fax | 760-355-2207
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Provider Business Mailing Address
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Address Line | PO BOX 1946
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City | EL CENTRO
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State | CA
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Zip | 92244-1946
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Country | US
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Telephone | 760-355-2207
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Fax | 760-355-2207
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Authorized Official
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Title or Position | SURGEON
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Name | DR. CHARLES R. HUMPHREY
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Credential | MD
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Telephone | 760-355-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G23919
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License Number State | CA
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