Healthcare Provider Details

I. General information

NPI: 1437386109
Provider Name (Legal Business Name): BRAD ALLEN OLBERDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 05/28/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E MCDOWELL RD 2ND FLOOR
PHOENIX AZ
85006-2502
US

IV. Provider business mailing address

1101 S. 10TH ST, STE 100
LINCOLN NE
68510-4293
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-2282
  • Fax:
Mailing address:
  • Phone: 402-483-4292
  • Fax: 855-895-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR71538
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27984
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: