Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 9405983 | KS |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 04-33336 | KS |
NPI | 1902960172 |
---|---|
Provider Name | Dr. Clinton D Humphrey |
First Address | Kansas City, MO 64141-1851 |
Second Address | Kansas City, KS 66160-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204511208 | (05) | MO |