Provider Demographics
NPI:1427291954
Name:HUMPHRIES, JERRY FRANKLIN JR (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:FRANKLIN
Last Name:HUMPHRIES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 KEATON CHASE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7789
Mailing Address - Country:US
Mailing Address - Phone:678-371-3627
Mailing Address - Fax:
Practice Address - Street 1:4311 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6123
Practice Address - Country:US
Practice Address - Phone:904-641-6628
Practice Address - Fax:904-642-1243
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112733207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine