Provider Demographics
NPI:1366403560
Name:HUMPHREYS, JAMES DELBERT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DELBERT
Last Name:HUMPHREYS
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 1:1661 AIRPORT RD STE D
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8184
Mailing Address - Country:US
Mailing Address - Phone:501-625-7500
Mailing Address - Fax:501-625-7777
Practice Address - Street 1:124 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7057
Practice Address - Country:US
Practice Address - Phone:501-624-0070
Practice Address - Fax:501-624-8721
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC 7486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR01272OtherCIGNA
AR1318800000OtherQUALCHOICE OF ARKANSAS
ARP01961OtherNOVASYS
AR110172671OtherRAILROAD MEDICARE
AR54677OtherARKANSAS BLUE CROSS BLUE SHIELD
AR54677OtherHEALTH ADVANTAGE
AR0120181OtherUNITED HEALTHCARE
AR485587OtherHEALTHLINK
AR5887035OtherAETNA
AR5887035OtherAETNA
AR1318800000OtherQUALCHOICE OF ARKANSAS
AR54677Medicare PIN