Provider Demographics
NPI:1881663730
Name:HUMBLE, ROBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:HUMBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3233
Mailing Address - Country:US
Mailing Address - Phone:704-633-6442
Mailing Address - Fax:704-633-7569
Practice Address - Street 1:605 GROVE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3233
Practice Address - Country:US
Practice Address - Phone:704-633-6442
Practice Address - Fax:704-633-7569
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400844207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-44577Medicaid
NC2199955BMedicare PIN
F82757Medicare UPIN
NC89-44577Medicaid