Provider Demographics
NPI:1629058060
Name:HARBERT, THOMAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:HARBERT
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 1:8560 FOXTAIL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6140
Mailing Address - Country:US
Mailing Address - Phone:402-219-3873
Mailing Address - Fax:402-499-3245
Practice Address - Street 1:8560 FOXTAIL DR STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-6140
Practice Address - Country:US
Practice Address - Phone:402-219-3873
Practice Address - Fax:402-499-3245
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20128207X00000X
SD4602207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6402000Medicaid
SD6402000Medicaid
SD6456Medicare ID - Type UnspecifiedMEDICARE #