Basic Information
| Provider Information | |||||||||
| NPI: | 1760740666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUMPAL | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 399 | ||||||||
| Address2: | 214 S 4TH ST | ||||||||
| City: | KREMMLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804590399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707243442 | ||||||||
| FaxNumber: | 9707249446 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 MT HIGHWAY 83 N | ||||||||
| Address2: | |||||||||
| City: | SEELEY LAKE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598688620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066772277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 80096 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.