Provider Demographics
NPI:1033791397
Name:DE ARMAS MEDINA, MARLON (MD)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:DE ARMAS MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982161 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-2161
Mailing Address - Country:US
Mailing Address - Phone:402-559-5700
Mailing Address - Fax:
Practice Address - Street 1:982161 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-6013
Practice Address - Country:US
Practice Address - Phone:402-955-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22424208D00000X
NE100092080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice