Basic Information
| Provider Information | |||||||||
| NPI: | 1902886260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMMER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | HARRISON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1931 TAMIAMI TRL STE 4-6 | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339482181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418880560 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Practice Location | |||||||||
| Address1: | 1931 TAMIAMI TRL STE 4-6 | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339482181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418880560 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 044242 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 044242 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 52701687 | 01 | GA | BCBS | OTHER | 000799361C | 05 | GA | MEDICAID | 110215327 | 01 | GA | RR MEDICARE-GRP # CC4177 | OTHER | 7600059 | 01 | GA | UNITED HEALTHCARE | OTHER | 000799361D | 05 | GA | MEDICAID | 000799361F | 05 | GA | MEDICAID | 10045199 | 01 | GA | AMERIGROUP | OTHER | 9941721 | 01 | GA | CIGNA | OTHER | 000799361E | 05 | GA | MEDICAID | 000799631B | 05 | GA | MEDICAID | 329332 | 01 | GA | WELLCARE | OTHER |