Healthcare Provider Details

I. General information

NPI: 1922098706
Provider Name (Legal Business Name): BENJAMIN DONALD BYERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST SUITE 712
LINCOLN NE
68506-1276
US

IV. Provider business mailing address

1500 S 48TH ST SUITE 712
LINCOLN NE
68506-1276
US

V. Phone/Fax

Practice location:
  • Phone: 315-767-2855
  • Fax:
Mailing address:
  • Phone: 315-767-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number1111
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number9044
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: