Provider Demographics
NPI:1013937374
Name:PENN, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:PENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 DODGE ST
Mailing Address - Street 2:SUITE 363
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4129
Mailing Address - Country:US
Mailing Address - Phone:402-354-8155
Mailing Address - Fax:402-354-8159
Practice Address - Street 1:8111 DODGE ST
Practice Address - Street 2:SUITE 363
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4129
Practice Address - Country:US
Practice Address - Phone:402-354-8155
Practice Address - Fax:402-354-8159
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE13129207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0923557Medicaid
MO202111902Medicaid
NE01565OtherBCBS
NE110002228Medicare PIN
NE097726Medicare PIN
D17252Medicare UPIN