Provider Demographics
NPI:1639185978
Name:HUMBERT, EDWARD THOMAS JR (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:THOMAS
Last Name:HUMBERT
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7331 COLLEGE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5524
Mailing Address - Country:US
Mailing Address - Phone:239-337-2003
Mailing Address - Fax:239-337-3168
Practice Address - Street 1:7331 COLLEGE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5524
Practice Address - Country:US
Practice Address - Phone:239-337-2003
Practice Address - Fax:239-337-3168
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8730207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29035OtherBCBS
0667439OtherAETNA
FL0460370001Medicare NSC
FL29035OtherBCBS
H35077Medicare UPIN