Individual
DR. BENJAMIN ROBERT FANGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8303 DODGE ST, OMAHA, NE 68114-4108
(402) 354-2360
(402) 354-2440
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1041
NE
208M00000X
Hospitalist Physician
Primary
1041
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041
MEDICAL LICENSE
NE
05
—
1689909673
—
IA
05
—
470687317-16
—
NE
Enumeration date
10/08/2009
Last updated
08/02/2017
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