Healthcare Provider Details

I. General information

NPI: 1902871692
Provider Name (Legal Business Name): ROBERT A VANDE GUCHTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 A ST STE 100
LINCOLN NE
68510-4120
US

IV. Provider business mailing address

6900 A ST STE 100
LINCOLN NE
68510-4120
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-2000
  • Fax: 402-436-2090
Mailing address:
  • Phone: 402-436-2000
  • Fax: 402-434-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20521
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number20521
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number20521
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: