Provider Demographics
NPI:1659462521
Name:HUMBLE, JOHN TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TIMOTHY
Last Name:HUMBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:810 HOSPITAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4600
Mailing Address - Country:US
Mailing Address - Phone:409-838-2611
Mailing Address - Fax:409-838-0026
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4600
Practice Address - Country:US
Practice Address - Phone:409-838-2611
Practice Address - Fax:409-838-0026
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8166208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0997Medicare PIN
TXC17214Medicare UPIN