Humphrey, Jon O

Humphrey, Jon O is an individual health care provider with primary practice located at 305 W Jackson St Suite 200, Carbondale IL 62901-1474. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Humphrey, Jon O can be contacted via phone (618) 453-3777.

Contact Information

Primary practice address
305 W Jackson St Suite 200 Carbondale IL 62901-1474
Phone: (618) 453-3777
Fax: (618) 453-1102
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 036-116062 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 67471 Tennessee

Profile Details

NPI number 1699972893
LBN Legal business name Humphrey, Jon O
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 29th, 2007
Last updated Jun 10th, 2024 - about 3 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699972893 NPPES
Illinois MEDICAID 036116062

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