Provider Demographics
NPI:1992816615
Name:HUMPHREY, JAMES A (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 STATE ROUTE 356
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-2033
Mailing Address - Country:US
Mailing Address - Phone:724-845-1145
Mailing Address - Fax:724-845-1679
Practice Address - Street 1:1181 STATE ROUTE 356
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-2033
Practice Address - Country:US
Practice Address - Phone:724-845-1145
Practice Address - Fax:724-845-1679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006017L173000000X
PAOS006017L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001180360Medicaid
11270085OtherCAQH
PAOS-006017LOtherMD LICENSE NUMBER
PA25-1878376OtherTAX IDENTIFICATION NUMBER