Basic Information
| Provider Information | |||||||||
| NPI: | 1093808545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDERBUR | ||||||||
| FirstName: | LARS | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 WEST DODGE ROAD | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029556877 | ||||||||
| FaxNumber: | 4029556880 | ||||||||
| Practice Location | |||||||||
| Address1: | 9202 WEST DODGE ROAD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029557500 | ||||||||
| FaxNumber: | 4029557524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22271 | NE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 239080 | 01 | NE | MIDLANDS CHOICE | OTHER | 47068937213 | 05 | NE | MEDICAID | 565671 | 05 | IA | MEDICAID | 2606 | 01 | NE | BCBS | OTHER |