MEDICARE: ROBERT L HUMBLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	016842	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285665554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L HUMBLE MD

Provider Business Mailing Address
First Line	:	130 DESIARD ST
Second Line	:	SUITE 355
City	:	MONROE
State	:	LA
Zip	:	71201-7319
Country	:	US
Telephone Number	:	318-807-7875
Fax Number	:	318-812-6603

Provider Business Practice Location Address
First Line	:	2516 BROADMOOR BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-2987
Country	:	US
Telephone Number	:	318-807-1390
Fax Number	:	318-807-1394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/12/2019

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