Provider Demographics
NPI:1043264062
Name:MANAHAN, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:MANAHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:535 FORTUNE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3428
Mailing Address - Country:US
Mailing Address - Phone:402-934-9033
Mailing Address - Fax:402-934-9506
Practice Address - Street 1:535 FORTUNE DR
Practice Address - Street 2:STE 200
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3428
Practice Address - Country:US
Practice Address - Phone:402-934-9033
Practice Address - Fax:402-934-9506
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE22754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE279439Medicare ID - Type Unspecified
NEI15847Medicare UPIN