Provider Demographics
NPI:1316249279
Name:ANSELMO H. HUMARAN MD,PA
Entity type:Organization
Organization Name:ANSELMO H. HUMARAN MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSELMO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-232-2066
Mailing Address - Street 1:11474 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6575
Mailing Address - Country:US
Mailing Address - Phone:305-232-2066
Mailing Address - Fax:
Practice Address - Street 1:11474 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6575
Practice Address - Country:US
Practice Address - Phone:305-232-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41680208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96178OtherMEDICARE ID
FL96178OtherMEDICARE ID