Provider Demographics
NPI:1902886260
Name:HUMMER, ROBERT HARRISON III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HARRISON
Last Name:HUMMER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 TAMIAMI TRL STE 4-6
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2181
Mailing Address - Country:US
Mailing Address - Phone:941-888-0560
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:1931 TAMIAMI TRL STE 4-6
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2181
Practice Address - Country:US
Practice Address - Phone:941-888-0560
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044242208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52701687OtherBCBS
GA000799361CMedicaid
GA110215327OtherRR MEDICARE-GRP # CC4177
GA7600059OtherUNITED HEALTHCARE
GA000799361DMedicaid
GA000799361FMedicaid
GA10045199OtherAMERIGROUP
GA9941721OtherCIGNA
GA000799361EMedicaid
GA000799631BMedicaid
GA329332OtherWELLCARE
GA110215327OtherRR MEDICARE-GRP # CC4177
GA000799361FMedicaid