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NPI Code Detail

MEDICARE: DR. CARL SCOTT HUMPHREY MD

MEDICARE:  DR. CARL SCOTT 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
1207X00000XOrthopaedic Surgery PhysicianM9563ID

General Provider Information

NPI Number : 1811978778
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARL SCOTT HUMPHREY MD
Provider Business Mailing Address
First Line : 3381 W BAVARIA STREET
Second Line :
City : EAGLE
State : ID
Zip : 83616-5341
Country : US
Telephone Number : 208-639-4800
Fax Number : 208-639-4801
Provider Business Practice Location Address
First Line : 3381 W BAVARIA STREET
Second Line :
City : EAGLE
State : ID
Zip : 83616-5341
Country : US
Telephone Number : 208-639-4800
Fax Number : 208-639-4801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 02/06/2012

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Directions to “ DR. CARL SCOTT HUMPHREY MD” Practice Location

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