Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | OS008403L | PA |
NPI | 1093793572 |
---|---|
Provider Name | Michael L Humphrey |
First Address | Altoona, PA 16602-2454 |
Second Address | Altoona, PA 16602-2454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 20/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001464990001 | (05) | PA |
F82204 | (02) |