Basic Information
| Provider Information | |||||||||
| NPI: | 1558756353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMPHRIES | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 7TH ST N | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396243997 | ||||||||
| FaxNumber: | 2396248101 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 7TH ST N | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396243997 | ||||||||
| FaxNumber: | 2396248101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2018-01790 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 209624 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2018-01790 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | ME140347 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 102802900 | 05 | FL | MEDICAID | BZ7R3 | 01 | FL | BCBS | OTHER |