Provider Demographics
NPI:1659360717
Name:HUME, DOUGLAS PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PETER
Last Name:HUME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:PETER
Other - Last Name:HUMENYY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8441 FILBERT CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5055
Mailing Address - Country:US
Mailing Address - Phone:910-257-7557
Mailing Address - Fax:
Practice Address - Street 1:8441 FILBERT CIR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-5055
Practice Address - Country:US
Practice Address - Phone:910-257-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33068207P00000X
TXR1389207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC70144Medicare UPIN