Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 6278 | TN |
NPI | 1043244684 |
---|---|
Provider Name | Dr. William Merritt Humphrey |
First Address | Cookeville, TN 38501 |
Second Address | Cookeville, TN 38501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 09/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3193466 | (05) | TN |
B04529 | (02) | TN |