MEDICARE: DR. JOHN STEWART HUMPHREY MD

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	208200000X	Plastic Surgery Physician	A99381	CA
2	208200000X	Plastic Surgery Physician	ME95230	FL
3	208200000X	Plastic Surgery Physician	2009 023 891	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	1270930001	OTHER		NORIDIAN/MEDICARE D-MERC
9	P00792431	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	43-1817986	OTHER		COMP RESULTS WORKERS COMP
3	43-1817986	OTHER		TRICARE/CHAMPUS/VA
5	000000633050	OTHER	MO	ANTHEM BLUE CROSS BLUE SHIELD
6	43-1817986	OTHER		CORVEL WORKERS COMP
7	PENDING	OTHER		GREAT WEST
8	979387	OTHER		HEALTHLINK

General Provider Information

NPI Number	:	1467496646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN STEWART HUMPHREY MD

Provider Business Mailing Address
First Line	:	319 S SILVER SPRINGS RD
Second Line	:	STE C
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6308
Country	:	US
Telephone Number	:	573-334-4263
Fax Number	:	573-334-3699

Provider Business Practice Location Address
First Line	:	319 S SILVER SPRINGS RD
Second Line	:	STE C
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6308
Country	:	US
Telephone Number	:	573-334-4263
Fax Number	:	573-334-3699

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	10/08/2010

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