Provider Demographics
NPI:1164420139
Name:HUMBLE, LEWIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:A
Last Name:HUMBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:323 MARION AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3639
Mailing Address - Country:US
Mailing Address - Phone:330-837-1111
Mailing Address - Fax:330-837-1769
Practice Address - Street 1:323 MARION AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3639
Practice Address - Country:US
Practice Address - Phone:330-837-1111
Practice Address - Fax:330-837-1769
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2033016Medicaid
OH2033016Medicaid
OHG52213Medicare UPIN