Basic Information
| Provider Information | |||||||||
| NPI: | 1831121086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIBBARD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3755 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681030755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023542100 | ||||||||
| FaxNumber: | 4023546171 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 N 103RD PLZ STE 100 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681141119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023915055 | ||||||||
| FaxNumber: | 4023915053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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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 | 207R00000X | 15753 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 15753 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 2086S0129X | 15753 | NE | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 10026480114 | 05 | NE | MEDICAID | 10026448100 | 05 | NE | MEDICAID | 1831121086 | 05 | IA | MEDICAID | 47037660406 | 05 | NE | MEDICAID |