MEDICARE: BRIAN E HUMPHERYS 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	207X00000X	Orthopaedic Surgery Physician	17658	MS

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2292722	OTHER	MS	AMERICAN ADMIN GROUP

General Provider Information

NPI Number	:	1861506792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN E HUMPHERYS MD

Provider Business Mailing Address
First Line	:	415 S 28TH AVE
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-7246
Country	:	US
Telephone Number	:	601-268-5630
Fax Number	:	601-579-5240

Provider Business Practice Location Address
First Line	:	7148 HWY 98 WEST
Second Line	:	SUITE 203
City	:	HATTIESBURG
State	:	MS
Zip	:	39402
Country	:	US
Telephone Number	:	601-268-5630
Fax Number	:	601-579-5240

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/01/2023

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Directions to “ BRIAN E HUMPHERYS MD” Practice Location

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