Provider Demographics
NPI:1437640067
Name:PURBAUGH, MATTHEW VERNON (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:VERNON
Last Name:PURBAUGH
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 1:2222 S 16TH ST STE 340
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3785
Mailing Address - Country:US
Mailing Address - Phone:402-483-8534
Mailing Address - Fax:
Practice Address - Street 1:2222 S 16TH ST STE 340
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3785
Practice Address - Country:US
Practice Address - Phone:402-483-8534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE339142084N0400X
NE82092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology