Provider Demographics
NPI:1114920543
Name:HASKINS, GREGORY EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:EUGENE
Last Name:HASKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 N CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7714
Mailing Address - Country:US
Mailing Address - Phone:402-721-7222
Mailing Address - Fax:402-721-2473
Practice Address - Street 1:2827 N CLARKSON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7714
Practice Address - Country:US
Practice Address - Phone:402-721-7222
Practice Address - Fax:402-721-2473
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15441207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47066963700Medicaid
NE0698450001Medicare NSC
NE095614Medicare PIN
NE47066963700Medicaid