Individual
DR. ROBERT S. PROFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 N CUSTER AVE, GRAND ISLAND, NE 68803-4311
(308) 382-1781
(308) 382-1474
Mailing address
711 N CUSTER AVE, GRAND ISLAND, NE 68803-4311
(308) 382-1781
(308) 382-1474
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
12878
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10-025813800
—
NE
01
—
12878
LICENSE
NE
01
—
180038420
RAILROAD MEDICARE PROVIDER NUMBER
NE
Enumeration date
05/24/2005
Last updated
05/12/2010
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