Individual
CHARLES T HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
6850 E HAVEN CT, MASON, OH 45040-5602
(337) 263-4958
Mailing address
6850 E HAVEN CT, MASON, OH 45040-5602
(337) 263-4958
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
024656
LA
207Q00000X
Family Medicine Physician
Primary
46156
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1571482
—
LA
Enumeration date
12/20/2005
Last updated
01/18/2017
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