MEDICARE: DR. JOHN WILLIAM HUMPHRIES D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN12511	FL

General Provider Information

NPI Number	:	1013176569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILLIAM HUMPHRIES D.M.D.

Provider Business Mailing Address
First Line	:	2505 S FEDERAL HWY # 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5922
Country	:	US
Telephone Number	:	772-464-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 S FEDERAL HWY # 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5922
Country	:	US
Telephone Number	:	772-464-4646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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