Provider Demographics
NPI:1033184957
Name:BRANUM, JOANNA HUMPREY (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:HUMPREY
Last Name:BRANUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 W 20TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-378-8000
Mailing Address - Fax:970-378-8088
Practice Address - Street 1:6801 W 20TH ST UNIT 101
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9640
Practice Address - Country:US
Practice Address - Phone:970-378-8000
Practice Address - Fax:970-378-8088
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039005207Q00000X
CO39005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87584034Medicaid
CO87584034Medicaid
COCO472228Medicare PIN
CO472228Medicare ID - Type Unspecified