Individual
FREDERIC A. HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4727 STATE ROUTE 60, MARIETTA, OH 45750-5360
(740) 374-4590
(740) 568-0310
Mailing address
4727 STATE ROUTE 60, MARIETTA, OH 45750-5360
(740) 374-4590
(740) 568-0310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34002561H
OH
207R00000X
Internal Medicine Physician
671
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000118170
ANTHEM
—
05
—
0083356000
—
WV
05
—
0367802
—
OH
Enumeration date
09/21/2005
Last updated
01/15/2015
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