Provider Demographics
NPI:1275647596
Name:HUMPHERYS, SCOTT BRETT (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRETT
Last Name:HUMPHERYS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 N 780 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042
Mailing Address - Country:US
Mailing Address - Phone:801-225-3095
Mailing Address - Fax:801-374-6254
Practice Address - Street 1:1928 N 1120 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-225-3095
Practice Address - Fax:801-374-6254
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3267960501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62218Medicare UPIN