Healthcare Provider Details

I. General information

NPI: 1376566646
Provider Name (Legal Business Name): RICHARD ALLEN CRUSINBERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 PINE LAKE RD
LINCOLN NE
68516-3389
US

IV. Provider business mailing address

5500 PINE LAKE RD
LINCOLN NE
68516-3389
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-8888
  • Fax: 402-421-1945
Mailing address:
  • Phone: 402-489-8888
  • Fax: 402-421-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number19017
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: