Individual
STEFAN G HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 MEMORIAL MEDICAL PKWY, DAYTONA BEACH, FL 32117-5167
(386) 231-6000
Mailing address
3152 LITTLE RD # 162, TRINITY, FL 34655-1864
(847) 289-5727
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
14305
NV
208100000X
Physical Medicine & Rehabilitation Physician
26359
AZ
208100000X
Physical Medicine & Rehabilitation Physician
37261
CO
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME148755
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10384750
CAQH
—
05
—
1346249315
—
NV
05
—
22137246
—
CO
Enumeration date
07/20/2005
Last updated
03/24/2021
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