Individual
LEA SARAH HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1203 E ROSS BYP, TAHLEQUAH, OK 74464-4133
(918) 453-1234
(918) 453-9107
Mailing address
100 MERCY WAY, STE 560, JOPLIN, MO 64804-4524
(417) 556-8555
(417) 556-8553
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
2010019023
MO
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
6819
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200593430A
—
OK
Enumeration date
07/29/2010
Last updated
10/04/2019
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