Provider Demographics
NPI:1932373255
Name:GUMP, WILLIAM CORBLY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CORBLY
Last Name:GUMP
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST STE 1105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3907
Practice Address - Country:US
Practice Address - Phone:502-583-1697
Practice Address - Fax:502-583-2120
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123127207T00000X
KY43547207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000052155ZOtherHUMANA - NNIKY
KY000000675413OtherANTHEM - NNIKY
KY289438OtherCIGNA - NNIKY
KY7100128470Medicaid
KY50029987OtherPASSPORT & PASSPORT ADVANTAGE - NNIKY
IN201019170Medicaid
KY118047OtherSIHO - NNIKY
KY50029987OtherPASSPORT & PASSPORT ADVANTAGE - NNIKY