Provider Demographics
NPI:1245271501
Name:HUMPHREY, LEE EUGENE (DPM)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:EUGENE
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 W 170TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8980
Mailing Address - Country:US
Mailing Address - Phone:913-897-3197
Mailing Address - Fax:
Practice Address - Street 1:407 S CLAIRBORNE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1723
Practice Address - Country:US
Practice Address - Phone:913-764-3120
Practice Address - Fax:913-764-3240
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000383213E00000X
KS12-00125213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO05071017OtherBS OF KANSAS CITY
KS006750OtherBS OF KANSAS
MO003385Medicare ID - Type UnspecifiedMEDICARE OF KANSAS CITY
MO05071017OtherBS OF KANSAS CITY