Provider Demographics
NPI:1104826338
Name:HUMBLE, KENT (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:HUMBLE
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 1:717 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-8311
Mailing Address - Country:US
Mailing Address - Phone:337-334-7551
Mailing Address - Fax:337-334-7556
Practice Address - Street 1:717 CURTIS DR
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-8311
Practice Address - Country:US
Practice Address - Phone:337-334-7551
Practice Address - Fax:337-334-7556
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL021972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1991571Medicaid
LAF87343Medicare UPIN
LA1991571Medicaid