Provider Demographics
NPI:1093808545
Name:VANDERBUR, LARS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LARS
Middle Name:E
Last Name:VANDERBUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8401 WEST DODGE ROAD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-955-6877
Mailing Address - Fax:402-955-6880
Practice Address - Street 1:9202 WEST DODGE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-955-7500
Practice Address - Fax:402-955-7524
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE22271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE239080OtherMIDLANDS CHOICE
NE47068937213Medicaid
IA565671Medicaid
NE2606OtherBCBS