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General NPI Number Information
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NPI Number | 1669812376
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Entity Type | Individual
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Provider Name | SARA M DESPAIN MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 2501 CAPEHART RD
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City | OFFUTT AFB
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State | NE
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Zip | 68113-1043
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Country | US
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Telephone | 812-219-4675
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CAPEHART RD
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City | OFFUTT AFB
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State | NE
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Zip | 68113-1043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V1761
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7058
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License Number State | NE
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