Provider Demographics
NPI:1902833072
Name:HUMPHREYS, DEAN ROBERT (NP)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:ROBERT
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 ESPERANCE TRL
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-4108
Mailing Address - Country:US
Mailing Address - Phone:315-652-9686
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER, 800 IRVING AVENUE
Practice Address - Street 2:CARDIOLOGY
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-425-2935
Practice Address - Fax:315-425-2937
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily