Individual
GARY NORMAN HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 EAST PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546
(616) 459-3158
Mailing address
1000 EAST PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-3680
(616) 459-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301042376
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104100751
BCBS OF MICHIGAN
MI
05
—
1373400
—
MI
Enumeration date
08/24/2006
Last updated
11/13/2018
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