Individual
JOHN MOORE HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01077327A
IN
208000000X
Pediatrics Physician
01077327A
IN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264910185
MEDICARE
IN
05
—
300014692
—
IN
Enumeration date
04/09/2009
Last updated
03/12/2025
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