Provider Demographics
NPI:1801965280
Name:BARON, BRUCE (DO)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BARON
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:PO BOX 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-0460
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:ALEGENT IMMANUEL HOSPITAL DEPT OF RADIOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1709
Practice Address - Country:US
Practice Address - Phone:402-572-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0959163Medicaid
IA1801965280Medicaid
IA0959163Medicaid
IA1801965280Medicaid
IAI20582Medicare PIN
NEF62896Medicare UPIN
NENA1355011Medicare PIN
NENA1356011Medicare PIN
NE$$$$$$$$$Medicaid
NEP00411713Medicare PIN
NE266530Medicare PIN
IAP00411727Medicare PIN
NE281461Medicare PIN