Individual
BARRY L FANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6901 N 72ND ST, ALEGENT IMMANUEL HOSPITAL DEPT OF RADIOLOGY, OMAHA, NE 68122-1709
(402) 572-2324
Mailing address
PO BOX 4460, OMAHA, NE 68104-0460
(866) 491-5807
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
17419
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0983783
—
IA
05
—
1245300565
—
IA
Enumeration date
11/08/2006
Last updated
02/01/2010
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