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NPI Code Detail

MEDICARE: DR. GERSON GIBRAN MANRIQUEZ MARTINEZ MD

MEDICARE:  DR. GERSON GIBRAN MANRIQUEZ MARTINEZ  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician8764NE
2207V00000XObstetrics & Gynecology PhysicianMD-53245IA

General Provider Information

NPI Number : 1417572918
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERSON GIBRAN MANRIQUEZ MARTINEZ MD
Provider Business Mailing Address
First Line : PO BOX 3755
Second Line :
City : OMAHA
State : NE
Zip : 68103-0755
Country : US
Telephone Number : 402-354-2100
Fax Number : 402-354-2155
Provider Business Practice Location Address
First Line : 808 E PIERCE ST
Second Line :
City : COUNCIL BLUFFS
State : IA
Zip : 51503-4601
Country : US
Telephone Number : 712-396-7880
Fax Number : 712-396-7885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2020
Last Update Date : 08/30/2024

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Directions to “ DR. GERSON GIBRAN MANRIQUEZ MARTINEZ MD” Practice Location

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