Provider Demographics
NPI:1619140639
Name:HUMPHREYS, JONATHAN RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RYAN
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J. RYAN
Other - Middle Name:
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 430127
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1127
Mailing Address - Country:US
Mailing Address - Phone:155-042-7736
Mailing Address - Fax:
Practice Address - Street 1:50 MEDICAL PARK DR E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD31916207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine