Provider Demographics
NPI:1336142264
Name:MABEN, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:MABEN
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 1:575 S 70TH ST
Mailing Address - Street 2:STE 310
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2471
Mailing Address - Country:US
Mailing Address - Phone:402-441-4760
Mailing Address - Fax:402-441-4764
Practice Address - Street 1:575 S 70TH ST
Practice Address - Street 2:STE 310
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-441-4760
Practice Address - Fax:402-441-4764
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21228208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE68510A005OtherTRIWEST PROVIDER ID
NE47056191312Medicaid
NE1700238OtherUHC PROVIDER ID
NE01323OtherBCBS PROVIDER ID
NE01323OtherBCBS PROVIDER ID
NE68510A005OtherTRIWEST PROVIDER ID