Healthcare Provider Details

I. General information

NPI: 1497704290
Provider Name (Legal Business Name): ANTHONY DOUGLAS RIFFEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST STE 605
LINCOLN NE
68506-1280
US

IV. Provider business mailing address

PO BOX 860879
MINNEAPOLIS MN
55486-0879
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-3255
  • Fax:
Mailing address:
  • Phone: 402-483-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02500
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 02500
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: