Provider Demographics
NPI:1205589793
Name:UMPHREY, MORRIS EDWARD JR
Entity type:Individual
Prefix:MR
First Name:MORRIS
Middle Name:EDWARD
Last Name:UMPHREY
Suffix:JR
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 1:4245 INNSLAKE DR APT 1315
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5507
Mailing Address - Country:US
Mailing Address - Phone:804-615-1613
Mailing Address - Fax:
Practice Address - Street 1:110 N ROBINSON ST STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4460
Practice Address - Country:US
Practice Address - Phone:804-615-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver