Provider Demographics
NPI:1609135375
Name:HUMPAL, MATTHEW RANDAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RANDAL
Last Name:HUMPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:712-264-3509
Practice Address - Street 1:501 1ST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-1703
Practice Address - Country:US
Practice Address - Phone:402-494-3064
Practice Address - Fax:712-294-7299
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-42604207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731712Medicaid
IA1609135375Medicaid
IA075120024Medicare PIN
IA058970061Medicare PIN