Provider Demographics
NPI:1881684850
Name:NEBEKER, HENRY GLEED (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:GLEED
Last Name:NEBEKER
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 1:255 E ORANGE GROVE AVE
Mailing Address - Street 2:STE D
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1240
Mailing Address - Country:US
Mailing Address - Phone:818-848-5595
Mailing Address - Fax:818-848-5749
Practice Address - Street 1:255 E ORANGE GROVE AVE
Practice Address - Street 2:STE D
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1240
Practice Address - Country:US
Practice Address - Phone:818-848-5595
Practice Address - Fax:818-848-5749
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43756207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069980Medicaid
G43756OtherCA LIC
G43756OtherCA LIC
G43756OtherCA LIC
CAGR0069980Medicaid