Provider Demographics
NPI:1679529507
Name:RIEKE, REUBEN D JR (PAC)
Entity Type:Individual
Prefix:MR
First Name:REUBEN
Middle Name:D
Last Name:RIEKE
Suffix:JR
Gender:M
Credentials:PAC
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Mailing Address - Street 1:UNMC SECTION OF NEUROSURGERY
Mailing Address - Street 2:982035 NEBRASKA MEDICAL CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-2035
Mailing Address - Country:US
Mailing Address - Phone:402-559-4280
Mailing Address - Fax:402-559-7779
Practice Address - Street 1:UNMC SECTION OF NEUROSURGERY
Practice Address - Street 2:982035 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-2035
Practice Address - Country:US
Practice Address - Phone:402-559-4280
Practice Address - Fax:402-559-7779
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NE1097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
277763Medicare ID - Type Unspecified
Q05508Medicare UPIN