Basic Information
| Provider Information | |||||||||
| NPI: | 1043313521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DEXTER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 COLUMBINE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033557666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 E 31ST STREET | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088657100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 11958 | NE | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
ID Information
| ID | Type | State | Issuer | Description | 47037975512 | 05 | NE | MEDICAID |