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1346249315

NPI Code Detail

MEDICARE: STEFAN G HUMPHRIES M.D.

MEDICARE: STEFAN G HUMPHRIES 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	208100000X	Physical Medicine & Rehabilitation Physician	14305	NV
2	208100000X	Physical Medicine & Rehabilitation Physician	37261	CO
3	208100000X	Physical Medicine & Rehabilitation Physician	26359	AZ
4	208100000X	Physical Medicine & Rehabilitation Physician	ME148755	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10384750	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346249315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN G HUMPHRIES M.D.

Provider Business Mailing Address
First Line	:	3152 LITTLE RD # 162
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-1864
Country	:	US
Telephone Number	:	847-289-5727
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 MEMORIAL MEDICAL PKWY
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5167
Country	:	US
Telephone Number	:	386-231-6000
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/24/2021

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Directions to “ STEFAN G HUMPHRIES M.D.” Practice Location

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