Individual
DR. DIEGO SEBASTIAN HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E. DOWNING #, TAHLEQUAH, OK 74464
(918) 207-0882
(918) 207-0335
Mailing address
PO BOX 1008, TAHLEQUAH, OK 74465-1008
(918) 207-0882
(918) 207-0335
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
19979
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100037340A
—
OK
Enumeration date
08/13/2006
Last updated
04/08/2020
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