MEDICARE: MR. DONALD PAUL SCARBOROUGH PA-C

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
1	363A00000X	Physician Assistant	001018	IA
2	363A00000X	Physician Assistant	2071	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720186109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD PAUL SCARBOROUGH PA-C

Provider Business Mailing Address
First Line	:	105 SOUTH 90TH ST. SUITE 201
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114
Country	:	US
Telephone Number	:	402-779-8400
Fax Number	:	402-779-8401

Provider Business Practice Location Address
First Line	:	11810 NICHOLAS ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4449
Country	:	US
Telephone Number	:	402-401-4404
Fax Number	:	402-999-7698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/31/2019

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