Individual
LYNNE A. HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD.
Contact information
Practice address
4100 MEDICAL CENTER DR, SUITE 104, FAYETTEVILLE, NY 13066-6635
(315) 663-0059
(315) 663-0123
Mailing address
5112 WEST TAFT ROAD, SUITE L, LIVERPOOL, NY 13088
(315) 452-2500
(314) 452-2510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
199458
NY
207Q00000X
Family Medicine Physician
Primary
199458.
NY
208M00000X
Hospitalist Physician
199458
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01790110
—
NY
Enumeration date
03/27/2006
Last updated
06/05/2023
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