MEDICARE: HENRY GLEED NEBEKER 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
1	207RN0300X	Nephrology Physician	G43756	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G43756	OTHER		CA LIC

General Provider Information

NPI Number	:	1881684850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY GLEED NEBEKER MD

Provider Business Mailing Address
First Line	:	255 E ORANGE GROVE AVE
Second Line	:	STE D
City	:	BURBANK
State	:	CA
Zip	:	91502-1240
Country	:	US
Telephone Number	:	818-848-5595
Fax Number	:	818-848-5749

Provider Business Practice Location Address
First Line	:	255 E ORANGE GROVE AVE
Second Line	:	STE D
City	:	BURBANK
State	:	CA
Zip	:	91502-1240
Country	:	US
Telephone Number	:	818-848-5595
Fax Number	:	818-848-5749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/07/2023

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