Healthcare Provider Details

I. General information

NPI: 1437171089
Provider Name (Legal Business Name): BENNETT R BARRIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 68TH STREET PL SUITE 100
LINCOLN NE
68510-2496
US

IV. Provider business mailing address

PO BOX 6951
LINCOLN NE
68506-0951
US

V. Phone/Fax

Practice location:
  • Phone: 402-327-7300
  • Fax: 402-327-7392
Mailing address:
  • Phone: 402-904-7135
  • Fax: 402-904-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number21750
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: