Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01081516A | IN |
N | 207Q00000X | Family Doctor | A83402 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 01081516A | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | A83402 | CA |
NPI | 1841507605 |
---|---|
Provider Name | John Edward Humiston |
First Address | Carmel, IN 46032-5892 |
Second Address | Carmel, IN 46032-5892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2010 |
Last Update Date | 17/03/2021 |