Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 39580 | IA |
N | 111NI0900X | Internist | 39580 | IA |
Y | 207R00000X | Internist | MD431085 | PA |
Y | 111NI0900X | Internist | MD431085 | PA |
N | 208D00000X | General Practice Physician | 0431207 | KS |
N | 208D00000X | General Practice Physician | 47001 | MN |
NPI | 1013134469 |
---|---|
Provider Name | Burt Humburg |
First Address | Mason City, IA 50401-2800 |
Second Address | Mason City, IA 50401-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100598 | GEISINGER HEALTH PLAN (01) | PA |
1570857 | GATEWAY-WMG (01) | PA |
20074392 | AMERIHEALTH MERCY-WMG (01) | PA |
2024764 | HIGHMARK BLUE SHIELD (01) | PA |
212420 | JOHNS HOPKINS (01) | PA |
239828 | UNISON-WMG (01) | PA |
263661 | UNISON-WMG GBH (01) | PA |
50077200 | CAPITAL BLUE CROSS-WMG (01) | PA |
50084012 | CAPITAL BLUE CROSS-WMG GBH (01) | PA |
930841 | CAREFIRST MD BCBS (01) | MD |
9989169 | AETNA (01) | PA |