Provider Demographics
NPI:1982622908
Name:HUMPHREY, RONALD L (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
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 1:112 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1357
Mailing Address - Country:US
Mailing Address - Phone:859-498-4529
Mailing Address - Fax:859-498-9505
Practice Address - Street 1:112 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1357
Practice Address - Country:US
Practice Address - Phone:859-498-4529
Practice Address - Fax:859-498-9505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190200Medicaid
KY1421501Medicare ID - Type Unspecified
KY64190200Medicaid