Provider Demographics
NPI:1558336503
Name:HUMPHREYS, RANDALL F
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:F
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 ST ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-785-2717
Mailing Address - Fax:850-785-2301
Practice Address - Street 1:2401 ST ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-785-2717
Practice Address - Fax:850-785-2301
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59222207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12097OtherBCBS OF FLORIDA
FL052572300Medicaid
FL052572300Medicaid