Provider Demographics
NPI:1720186109
Name:SCARBOROUGH, DONALD PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:PAUL
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOUTH 90TH ST. SUITE 201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-779-8400
Mailing Address - Fax:402-779-8401
Practice Address - Street 1:11810 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4449
Practice Address - Country:US
Practice Address - Phone:402-401-4404
Practice Address - Fax:402-999-7698
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001018363A00000X
NE2071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731777Medicaid
NE47068731777Medicaid
IA07512001Medicare PIN
IA058970007Medicare PIN