Provider Demographics
NPI:1033184957
Name:BRANUM, JOANNA HUMPREY (MD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:HUMPREY
Last Name:BRANUM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 W 20TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3033
Mailing Address - Country:US
Mailing Address - Phone:970-353-2000
Mailing Address - Fax:
Practice Address - Street 1:8217 W 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3033
Practice Address - Country:US
Practice Address - Phone:970-353-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039005207Q00000X
CO39005207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87584034Medicaid
CO87584034Medicaid
COCO472228Medicare PIN
CO472228Medicare ID - Type Unspecified