Provider Demographics
NPI:1740269679
Name:HUMBERT, VERNON H JR (MD)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:H
Last Name:HUMBERT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1305 N ELM ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2783
Mailing Address - Country:US
Mailing Address - Phone:270-830-4756
Mailing Address - Fax:270-830-4738
Practice Address - Street 1:1305 N ELM ST
Practice Address - Street 2:SUITE C
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2783
Practice Address - Country:US
Practice Address - Phone:270-830-4756
Practice Address - Fax:270-830-4738
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01038632207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64170673Medicaid
IN100102490Medicaid
IN100102490Medicaid
KYK114302Medicare PIN
KY1828601Medicare PIN