Provider Demographics
NPI:1588615314
Name:HUMBERT, TRACEY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:R
Last Name:HUMBERT
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:PO BOX 55845
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5845
Mailing Address - Country:US
Mailing Address - Phone:205-279-2860
Mailing Address - Fax:205-252-0197
Practice Address - Street 1:1515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-918-2330
Practice Address - Fax:205-251-7698
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938008Medicaid
AL009938006Medicaid
AL009938004Medicaid
AL009938003Medicaid
AL009938007Medicaid
AL009938006Medicaid