Provider Demographics
NPI:1245330760
Name:POOLE, BRIAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:POOLE
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 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2714
Mailing Address - Country:US
Mailing Address - Phone:402-506-9000
Mailing Address - Fax:402-315-2738
Practice Address - Street 1:7100 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2714
Practice Address - Country:US
Practice Address - Phone:402-506-9000
Practice Address - Fax:402-315-2738
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23248207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01675OtherBCBS IA
NEP00224639OtherRAILROAD MEDICARE
IAP00673801OtherRAILROAD MEDICARE
IA0591750Medicaid
NE30041OtherBCBS
NEI31031Medicare UPIN
NENA1910006Medicare PIN
IAP00673801OtherRAILROAD MEDICARE
NE278963Medicare PIN