Individual
DR. LAUREL L. HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
TWO ST. MARK'S PLACE, SUITE 130, LA GRANGE, TX 78945-1259
(979) 242-5605
(979) 242-5619
Mailing address
TWO ST. MARK'S PLACE, SUITE 130, LA GRANGE, TX 78945-1259
(979) 242-5605
(979) 242-5619
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
208600000X
Surgery Physician
Primary
M1773
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184272601
—
TX
Enumeration date
06/20/2006
Last updated
01/04/2024
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