Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | DO-05199 | IA |
N | 207Q00000X | Family Doctor | R10702 | IA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2256 | NE |
N | 207QS0010X | Family Doctor - Sports Medicine | DO-05199 | IA |
NPI | 1134571862 |
---|---|
Provider Name | Amard Abcejo |
First Address | Omaha, NE 68144-5253 |
Second Address | Omaha, NE 68144-5253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2016 |
Last Update Date | 28/12/2020 |