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NPI Code Detail

MEDICARE: DR. LEWIS GILBERT HUMPHREYS JR. D.M.D.

MEDICARE: DR. LEWIS GILBERT HUMPHREYS JR. D.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
11223P0300XPeriodontics3595AL

General Provider Information

NPI Number : 1851474233
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEWIS GILBERT HUMPHREYS JR. D.M.D.
Provider Business Mailing Address
First Line : 102 MEDICAL DR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-6902
Country : US
Telephone Number : 334-792-7888
Fax Number : 334-792-8717
Provider Business Practice Location Address
First Line : 102 MEDICAL DR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-6902
Country : US
Telephone Number : 334-792-7888
Fax Number : 334-792-8717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 06/05/2009

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