Provider Demographics
NPI:1326088469
Name:HUMPHREYS, BRIAN F (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:F
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:F
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACS
Mailing Address - Street 1:121 GASLIGHT MEDICAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3150
Mailing Address - Country:US
Mailing Address - Phone:936-699-3141
Mailing Address - Fax:936-699-3145
Practice Address - Street 1:121 GASLIGHT MEDICAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3150
Practice Address - Country:US
Practice Address - Phone:936-699-3141
Practice Address - Fax:936-699-3145
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1496207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132380007Medicaid
TX132380007Medicaid