Provider Demographics
NPI:1427218577
Name:RECOB, SAMUEL J (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:RECOB
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 1:218 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NE
Mailing Address - Zip Code:68745-1989
Mailing Address - Country:US
Mailing Address - Phone:402-256-3042
Mailing Address - Fax:402-256-3043
Practice Address - Street 1:218 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NE
Practice Address - Zip Code:68745-1989
Practice Address - Country:US
Practice Address - Phone:402-256-3042
Practice Address - Fax:402-256-3043
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8352207Q00000X
NE25320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine