Basic Information
| Provider Information | |||||||||
| NPI: | 1881818441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMPHERYS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | LEGRAND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057558107 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1635 CAREGIVER CIR | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577028529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057556100 | ||||||||
| FaxNumber: | 6057556101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 11/27/2019 | ||||||||
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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 | 207X00000X | 11409 | SD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.