Healthcare Provider Details

I. General information

NPI: 1316982093
Provider Name (Legal Business Name): JOHN P CALABRO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 FARNAM DR SUITE 305
OMAHA NE
68114-3426
US

IV. Provider business mailing address

PO BOX 241353
OMAHA NE
68124-5353
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-9243
  • Fax: 402-398-9253
Mailing address:
  • Phone: 402-398-9243
  • Fax: 402-398-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: