Individual
DR. JUSTIN GERHARD MADSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PHD
Contact information
Practice address
4242 FARNAM ST., SUITE 360, OMAHA, NE 68131-2850
(402) 552-2555
(402) 552-2598
Mailing address
4242 FARNAM ST, SUITE 360, OMAHA, NE 68131-2806
(402) 552-2555
(402) 552-2573
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
26614
NE
207N00000X
Dermatology Physician
27129
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OK403917
MEDICARE INDIVIDUAL PTAN
OK
Enumeration date
09/16/2008
Last updated
09/02/2014
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