Provider Demographics
NPI:1962594390
Name:OBREGON, HEATHER A (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:OBREGON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-365-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:5908 S 142ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2800
Practice Address - Country:US
Practice Address - Phone:402-354-1900
Practice Address - Fax:402-354-1910
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND7250207Q00000X
NE24717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731706Medicaid
IA1962594390Medicaid
NE099099030Medicare PIN
NE47068731706Medicaid