Organization
CHARLES R. HUMPHREY, M.D.,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES R. HUMPHREY MD (SURGEON)
(760) 355-2207
Entity
Organization
Contact information
Practice address
1415 ROSS AVE, EL CENTRO, CA 92243-4306
(760) 355-2207
(760) 355-2207
Mailing address
PO BOX 1946, EL CENTRO, CA 92244-1946
(760) 355-2207
(760) 355-2207
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G23919
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G239190
—
CA
01
—
W1580
MEDICARE ID
CA
Enumeration date
05/18/2007
Last updated
02/28/2008
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