Provider Demographics
NPI:1437234812
Name:JOHN R. HUMPHRIES, M.D., APMC
Entity Type:Organization
Organization Name:JOHN R. HUMPHRIES, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-235-3016
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-235-3016
Mailing Address - Fax:337-269-0230
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:SUITE 408
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-235-3016
Practice Address - Fax:337-269-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.012665207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4357678990OtherBLUE CROSS BLUE SHIELD
LA1320676Medicaid
LA5M164Medicare ID - Type Unspecified
LA1320676Medicaid