Provider Demographics
NPI:1992875348
Name:JOHN T. HUMBLE MD, PA
Entity type:Organization
Organization Name:JOHN T. HUMBLE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-838-2611
Mailing Address - Street 1:810 HOSPITAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4600
Mailing Address - Country:US
Mailing Address - Phone:409-838-2611
Mailing Address - Fax:409-838-0026
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4600
Practice Address - Country:US
Practice Address - Phone:409-838-2611
Practice Address - Fax:409-838-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8166208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC17214Medicare UPIN
TX00376UMedicare PIN