Provider Demographics
NPI:1730153198
Name:HUMMEL, GREGORY L (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:HUMMEL
Suffix:
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:PO BOX 1980
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-0980
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:19550 E 39TH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057
Practice Address - Country:US
Practice Address - Phone:816-252-7300
Practice Address - Fax:816-836-8435
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2024-10-02
Deactivation Date:2022-03-26
Deactivation Code:
Reactivation Date:2024-10-02
Provider Licenses
StateLicense IDTaxonomies
MOR3B53207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11096035OtherBCBS
MO202067518Medicaid
MO0412530001Medicare NSC
E04823Medicare UPIN
MO202067518Medicaid
MO200013741Medicare PIN