Provider Demographics
NPI:1295065886
Name:HUMPHREY, MARTHA ROBB (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ROBB
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7543 STONE RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5237
Mailing Address - Country:US
Mailing Address - Phone:801-943-7421
Mailing Address - Fax:801-943-3254
Practice Address - Street 1:7543 STONE RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5237
Practice Address - Country:US
Practice Address - Phone:801-943-7421
Practice Address - Fax:801-943-3254
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1638231205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine