Provider Demographics
NPI:1144392432
Name:HUMPHRIES, DENNIS VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:VICTOR
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12061 SHERATON LANE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1611
Mailing Address - Country:US
Mailing Address - Phone:513-671-3636
Mailing Address - Fax:513-671-4419
Practice Address - Street 1:12061 SHERATON LANE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1611
Practice Address - Country:US
Practice Address - Phone:513-671-3636
Practice Address - Fax:513-671-4419
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35030301208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A71326Medicare UPIN
HU0147462Medicare ID - Type Unspecified