Provider Demographics
NPI:1265082143
Name:HUMPHREYS, JOEL ALAN
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ALAN
Last Name:HUMPHREYS
Suffix:
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:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97462-0262
Mailing Address - Country:US
Mailing Address - Phone:541-459-3116
Mailing Address - Fax:
Practice Address - Street 1:205 PEAR ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:OR
Practice Address - Zip Code:97462-3002
Practice Address - Country:US
Practice Address - Phone:541-459-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty