Provider Demographics
NPI:1023149440
Name:HUMPHRIES, SIMON ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:ANTHONY
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:811 ALTOS OAKS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5426
Mailing Address - Country:US
Mailing Address - Phone:650-917-6920
Mailing Address - Fax:650-917-6925
Practice Address - Street 1:811 ALTOS OAKS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5426
Practice Address - Country:US
Practice Address - Phone:650-917-6920
Practice Address - Fax:650-917-6925
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG067109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02188Medicare UPIN
00G671090Medicare ID - Type Unspecified