Provider Demographics
NPI:1144383449
Name:GOBBO, PAUL N
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:N
Last Name:GOBBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S 48TH ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1276
Mailing Address - Country:US
Mailing Address - Phone:402-483-8560
Mailing Address - Fax:402-486-4953
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 605
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-483-8560
Practice Address - Fax:402-486-4953
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18104207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE32255OtherBLUE CROSS BLUE SHIELD
NEP00398704OtherRAILROAD MEDICARE
NE0402823OtherUHC SHARE ADVANTAGE
NEP00398704OtherRAILROAD MEDICARE
NE281313Medicare PIN