Provider Demographics
NPI:1174729016
Name:HRUBY, PAUL MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:HRUBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1524 CUMING ST APT 501
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-4436
Mailing Address - Country:US
Mailing Address - Phone:402-321-1146
Mailing Address - Fax:
Practice Address - Street 1:9800 BAPTIST HEALTH DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6243
Practice Address - Country:US
Practice Address - Phone:501-219-0900
Practice Address - Fax:501-312-4750
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5622207R00000X
ARE9102207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR209651001Medicaid