Individual
TU HA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7500 MERCY RD STE 1355, OMAHA, NE 68124-2319
(402) 717-4866
Mailing address
PO BOX 70060, TUCSON, AZ 85737-0026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34470
NE
207L00000X
Anesthesiology Physician
59451
AZ
207L00000X
Anesthesiology Physician
61002525
WA
207L00000X
Anesthesiology Physician
7482
NE
Other
Enumeration date
06/16/2015
Last updated
07/19/2022
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