Organization
DFAS-JFLL/IN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISAAC HUMPHREY MD (SUPERVISOR)
(937) 257-9926
Entity
Organization
Contact information
Practice address
4881 SUGAR MAPLE DR, DAYTON, OH 45433-5529
(937) 257-9926
Mailing address
4881 SUGAR MAPLE DR, DAYTON, OH 45433-5529
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
01073515A
IN
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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