Healthcare Provider Details

I. General information

NPI: 1962594390
Provider Name (Legal Business Name): HEATHER A OBREGON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 S 142ND ST
OMAHA NE
68137-2800
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-1900
  • Fax: 402-354-1910
Mailing address:
  • Phone: 402-365-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7250
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24717
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: