Provider Demographics
NPI:1629063508
Name:ATTEBERRY, THOMAS MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARVIN
Last Name:ATTEBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 EDMUNDSON PL
Mailing Address - Street 2:STE 500
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4619
Mailing Address - Country:US
Mailing Address - Phone:712-323-5333
Mailing Address - Fax:712-323-3252
Practice Address - Street 1:1 EDMUNDSON PL
Practice Address - Street 2:STE 500
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4619
Practice Address - Country:US
Practice Address - Phone:712-323-5333
Practice Address - Fax:712-323-3252
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE23828207X00000X
IA36716207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE251375OtherMIDLANDS CHOICE
IA28557OtherWELLMARK
IAP00333529OtherRAILROAD MEDICARE
NE31178OtherBCBS OF NEBRASKA
NE31178OtherBCBS OF NEBRASKA