Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 200501674 | NC |
Y | 2086S0102X | Surgical Critical Care | 29250 | NE |
N | 2086S0127X | Trauma Surgeon | 200501674 | NC |
NPI | 1003832254 |
---|---|
Provider Name | Dr. Brett Waibel |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-2849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 10/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142NW | BCBS NC (01) | NC |
5904104 | (05) | NC |
I62062 | (02) | NC |
P00380296 | RAILROAD MEDICARE (01) | NC |