Healthcare Provider Details

I. General information

NPI: 1821101718
Provider Name (Legal Business Name): DONALD L GIBBENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST SUITE 400
LINCOLN NE
68506-1275
US

IV. Provider business mailing address

1600 S 48TH ST SUITE 400
LINCOLN NE
68506-1275
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-8877
  • Fax: 402-475-8941
Mailing address:
  • Phone: 402-475-8877
  • Fax: 402-475-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number17224
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: