Provider Demographics
NPI:1336225879
Name:HUMPHREY, WILLIAM ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LITTLEBURY RD SE
Mailing Address - Street 2:BUILDING 8 STE 22
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1826
Mailing Address - Country:US
Mailing Address - Phone:256-533-6003
Mailing Address - Fax:
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-651-5374
Practice Address - Fax:425-930-3274
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12374207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4810053OtherUHC PROVIDER #
AL000080772Medicaid
AL290009999OtherRR MEDICARE PROVIDER #
AL4080781OtherAETNA PROVIDER #
AL80772OtherBCBS OF AL PROVIDER #
TN4401083Medicaid
AL80772OtherBCBS OF AL PROVIDER #
AL000080772Medicare ID - Type UnspecifiedMEDICARE PROVIDER #