Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1699PT | MT |
NPI | 1073662169 |
---|---|
Provider Name | Dr. Jeffrey Ernest Humphrey |
First Address | Corvallis, MT 59828-9340 |
Second Address | Corvallis, MT 59828-9340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00348874 | (05) | MT |
011001911 | (02) | MT |
61278 | BLUECROSS BLUESHIELD (01) | MT |
P00708924 | RAILROAD MEDICARE (01) | MT |