Provider Demographics
NPI:1811041304
Name:BOSSERT, ROBERT C (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:BOSSERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16910 MARCY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2704
Mailing Address - Country:US
Mailing Address - Phone:402-697-7200
Mailing Address - Fax:402-697-7282
Practice Address - Street 1:16910 MARCY ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2704
Practice Address - Country:US
Practice Address - Phone:402-697-7200
Practice Address - Fax:402-697-7282
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21218207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02640OtherBCBS ID
IA0520130Medicaid
NE02640OtherBCBS ID
NE272036Medicare ID - Type UnspecifiedMEDICARE ID