Provider Demographics
NPI:1285812073
Name:HUMPHREY, IRVING L (MD)
Entity type:Individual
Prefix:
First Name:IRVING
Middle Name:L
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IRVING
Other - Middle Name:L
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14673 MIDWAY RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3171
Mailing Address - Country:US
Mailing Address - Phone:972-404-8677
Mailing Address - Fax:
Practice Address - Street 1:4230 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 410
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5806
Practice Address - Country:US
Practice Address - Phone:972-404-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD78392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry