Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 18056 | NE |
N | 207ND0101X | MOHS-Micrographic Surgeon | 18056 | NE |
N | 207ND0900X | Dermatopathologist | 18056 | NE |
N | 207NP0225X | Pediatric Dermatologist | 18056 | NE |
N | 207NS0135X | Procedural Dermatology | 18056 | NE |
NPI | 1417946484 |
---|---|
Provider Name | Dr. Mark D Heibel |
First Address | Lincoln, NE 68516-4473 |
Second Address | Lincoln, NE 68516-4473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 15/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070016194 | PALMETTO-RAILROAD MEDICAR (01) | NE |
35672 | BLUE CROSS BLUE SHIELD (01) | NE |
39203650100 | (05) | NE |
F93898 | (02) | NE |