Healthcare Provider Details

I. General information

NPI: 1336142264
Provider Name (Legal Business Name): ROBERT E MABEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S 70TH ST STE 310
LINCOLN NE
68510-2471
US

IV. Provider business mailing address

575 S 70TH ST STE 310
LINCOLN NE
68510-2471
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-4760
  • Fax: 402-441-4764
Mailing address:
  • Phone: 402-441-4760
  • Fax: 402-441-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21228
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: