Provider Demographics
NPI:1164426946
Name:HUMPHREY, ALFRED LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:LEON
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2801 LEMMON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2356
Mailing Address - Country:US
Mailing Address - Phone:214-754-0000
Mailing Address - Fax:214-379-1849
Practice Address - Street 1:910 N DAVIS DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3200
Practice Address - Country:US
Practice Address - Phone:817-461-0199
Practice Address - Fax:817-460-2153
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD5043207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115671304Medicaid
TX8J7027Medicare PIN
TX115671304Medicaid
TXP00608724Medicare PIN