Provider Demographics
NPI:1013134469
Name:HUMBURG, BURT (MD)
Entity Type:Individual
Prefix:
First Name:BURT
Middle Name:
Last Name:HUMBURG
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 1:1000 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2800
Mailing Address - Country:US
Mailing Address - Phone:641-428-7000
Mailing Address - Fax:641-428-6383
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-428-7000
Practice Address - Fax:641-428-6383
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431085207R00000X, 208M00000X
KS0431207208D00000X
MN47001208D00000X
IA39580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD930841OtherCAREFIRST MD BCBS
PA263661OtherUNISON-WMG GBH
PA100598OtherGEISINGER HEALTH PLAN
PA50077200OtherCAPITAL BLUE CROSS-WMG
PA1570857OtherGATEWAY-WMG
PA2024764OtherHIGHMARK BLUE SHIELD
PA212420OtherJOHNS HOPKINS
PA20074392OtherAMERIHEALTH MERCY-WMG
PA50084012OtherCAPITAL BLUE CROSS-WMG GBH
PA9989169OtherAETNA
PA239828OtherUNISON-WMG
PAP00669534Medicare PIN
PA100598OtherGEISINGER HEALTH PLAN