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NPI Code Detail

MEDICARE: KERRY RODABAUGH MD

MEDICARE: KERRY RODABAUGH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician222953-1NY
2207VX0201XGynecologic Oncology Physician24824NE

General Provider Information

NPI Number : 1528049798
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY RODABAUGH MD
Provider Business Mailing Address
First Line : 988102 NEBRASKA MEDICAL CTR
Second Line :
City : OMAHA
State : NE
Zip : 68198-8102
Country : US
Telephone Number : 402-559-4500
Fax Number : 402-559-9416
Provider Business Practice Location Address
First Line : 988102 NEBRASKA MEDICAL CTR
Second Line :
City : OMAHA
State : NE
Zip : 68198-8102
Country : US
Telephone Number : 402-559-4500
Fax Number : 402-559-9416
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 01/29/2013

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