Basic Information
| Provider Information | |||||||||
| NPI: | 1508210469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUMBLE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 RIVERSIDE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240164962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405810338 | ||||||||
| FaxNumber: | 5409856920 | ||||||||
| Practice Location | |||||||||
| Address1: | 1906 BELLEVIEW AVE SE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405810338 | ||||||||
| FaxNumber: | 5409856920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2016 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 0101270966 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.