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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
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