Provider Demographics
NPI:1922098706
Name:BYERS, BENJAMIN DONALD (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DONALD
Last Name:BYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S 48TH ST
Mailing Address - Street 2:SUITE 712
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1276
Mailing Address - Country:US
Mailing Address - Phone:315-767-2855
Mailing Address - Fax:
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 712
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:315-767-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1111207VM0101X
SD9044207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760010407OtherEIN
TX760010407OtherEIN
TX8K0205Medicare PIN
TXCI5830Medicare PIN