MEDICARE: JOHN 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	207L00000X	Anesthesiology Physician	H0480	TX

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	8BK799	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8EH268	OTHER	TX	BCBS TX
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	P00719219	OTHER	TX	RAILROAD

General Provider Information

NPI Number	:	1881698769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN HUMPHREY MD

Provider Business Mailing Address
First Line	:	4144 N CENTRAL EXPY
Second Line	:	STE 700
City	:	DALLAS
State	:	TX
Zip	:	75204-3130
Country	:	US
Telephone Number	:	214-252-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4144 N CENTRAL EXPY
Second Line	:	STE 700
City	:	DALLAS
State	:	TX
Zip	:	75204-3130
Country	:	US
Telephone Number	:	214-252-3501
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/28/2015

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Directions to “ JOHN HUMPHREY MD” Practice Location

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