MEDICARE: DR. ROGER LEA HUMPHREY 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	208600000X	Surgery Physician	01046282A	IN
2	2086S0129X	Vascular Surgery Physician	01046282A	IN
3	2086S0129X	Vascular Surgery Physician	19761	KY
4	208600000X	Surgery Physician	19761	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	020038275	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200132180	OTHER	IN	MOLINA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	611059472	OTHER	KY	DART
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	6110594722109	OTHER	IN	CARESOURCE
6	000000048413	OTHER	KY	ANTHEM
7	611059472	OTHER		UMWA

General Provider Information

NPI Number	:	1245239292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER LEA HUMPHREY M.D.

Provider Business Mailing Address
First Line	:	2801 NEW HARTFORD RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1320
Country	:	US
Telephone Number	:	270-683-3720
Fax Number	:	270-686-7331

Provider Business Practice Location Address
First Line	:	2801 NEW HARTFORD RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1320
Country	:	US
Telephone Number	:	270-683-3720
Fax Number	:	270-686-7331

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	11/27/2023

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Directions to “ DR. ROGER LEA HUMPHREY M.D.” Practice Location

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