Provider Demographics
NPI:1952779977
Name:SOUTH FLORIDA INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:SOUTH FLORIDA INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-664-7810
Mailing Address - Street 1:5915 PONCE DE LEON BLVD STE 26
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2435
Mailing Address - Country:US
Mailing Address - Phone:786-664-7810
Mailing Address - Fax:305-340-2646
Practice Address - Street 1:5915 PONCE DE LEON BLVD STE 26
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2435
Practice Address - Country:US
Practice Address - Phone:786-664-7810
Practice Address - Fax:305-340-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8545103T00000X
FL1-13-14627103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty