Provider Demographics
NPI:1295785525
Name:HERBIN, BRIAN JEAN (PA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JEAN
Last Name:HERBIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2455 PINE LAKE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3665
Mailing Address - Country:US
Mailing Address - Phone:402-423-1111
Mailing Address - Fax:402-423-0365
Practice Address - Street 1:8040 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9371
Practice Address - Country:US
Practice Address - Phone:402-423-1111
Practice Address - Fax:402-423-0365
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1038207NS0135X, 363A00000X, 363AS0400X, 207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP61993Medicare UPIN