Provider Demographics
NPI:1518050848
Name:IMBROCK, JAMES DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:IMBROCK
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 1:7710 MERCY RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-399-9313
Mailing Address - Fax:402-399-9314
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 309
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-399-9313
Practice Address - Fax:402-399-9314
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE13591208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00587OtherBCBS NEBRASKA
NE42-1158718-00Medicaid
B67820Medicare UPIN