Provider Demographics
NPI:1235367236
Name:HUMPHREY, CHRISTINE S (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7374
Mailing Address - Country:US
Mailing Address - Phone:916-851-1440
Mailing Address - Fax:
Practice Address - Street 1:3201 DATA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7374
Practice Address - Country:US
Practice Address - Phone:916-851-1440
Practice Address - Fax:530-387-8006
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447045207Q00000X
CA135462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine