Organization
MOD DERMATOLOGY PC
Active
Organization
MOD DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAINA PATERA MBA (PRACTICE MANAGER)
(402) 505-8777
Entity
Organization
Contact information
Practice address
16910 FRANCES ST, OMAHA, NE 68130-2398
(402) 505-8777
(402) 933-7767
Mailing address
16910 FRANCES ST, OMAHA, NE 68130-2398
(402) 505-8777
(402) 933-7767
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207N00000X
Dermatology Physician
Primary
28493
NE
207N00000X
Dermatology Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
02/21/2018
Last updated
01/20/2023
Update your record
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