Provider Demographics
NPI:1093787491
Name:HUMAN, DONALD A (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:HUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 E CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2319
Mailing Address - Country:US
Mailing Address - Phone:520-840-0312
Mailing Address - Fax:480-657-2015
Practice Address - Street 1:6451 N FEDERAL HWY
Practice Address - Street 2:SUITE 800
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1402
Practice Address - Country:US
Practice Address - Phone:954-343-2114
Practice Address - Fax:800-463-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17895207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ281428Medicaid
AZAZ0890620OtherBLUECROSS BLUESHIELD
AZAZ0890620OtherBLUECROSS BLUESHIELD
AZZ118936Medicare PIN
D45714Medicare UPIN