Provider Demographics
NPI:1548210438
Name:EBKE, RUSSELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:EBKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-0220
Mailing Address - Country:US
Mailing Address - Phone:402-826-2102
Mailing Address - Fax:402-826-7950
Practice Address - Street 1:2910 BETTEN DR
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3084
Practice Address - Country:US
Practice Address - Phone:402-826-2102
Practice Address - Fax:402-826-7950
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE17808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2703OtherMIDLANDS CHOICE
NE0100476OtherUNITED HEALTHCARE
NE35706OtherBCBS OF NEBRASKA
NE0100475OtherUNITED HEALTHCARE
NE080178127OtherRAILROAD MEDICARE
NE2703OtherMIDLANDS CHOICE
NE35706OtherBCBS OF NEBRASKA