Provider Demographics
NPI:1073615209
Name:HOBERMAN, CLAYTON JEPSEN (DO)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:JEPSEN
Last Name:HOBERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 N 115TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4423
Mailing Address - Country:US
Mailing Address - Phone:402-609-4818
Mailing Address - Fax:402-502-4567
Practice Address - Street 1:1065 N 115TH ST STE 120
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4423
Practice Address - Country:US
Practice Address - Phone:402-609-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE687207QH0002X, 2081H0002X
IA40202081H0002X
WI71820-212081H0002X
KS05-421702081H0002X
IL036-1581662081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360021Medicare PIN