1619140639 NPI number — DR. JONATHAN RYAN HUMPHREYS M.D.

Table of content: DR. JONATHAN RYAN HUMPHREYS M.D. (NPI 1619140639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619140639 NPI number — DR. JONATHAN RYAN HUMPHREYS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMPHREYS
Provider First Name:
JONATHAN
Provider Middle Name:
RYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUMPHREYS
Provider Other First Name:
J. RYAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619140639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 430127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35243-1127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
155-042-7736
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MEDICAL PARK DR E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-838-3970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD31916 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)