MEDICARE: DR. CAROL HUMPHRY 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	207Q00000X	Family Medicine Physician	G75480	CA

General Provider Information

NPI Number	:	1326029257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL HUMPHRY M.D.

Provider Business Mailing Address
First Line	:	808 SE CHKALOV DR
Second Line	:	STE. 3 - 165
City	:	VANCOUVER
State	:	WA
Zip	:	98683
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	528 CHIEF EDDIE HOFFMAN HWY
Second Line	:
City	:	BETHEL
State	:	AK
Zip	:	99559
Country	:	US
Telephone Number	:	907-543-6300
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	11/12/2024

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