Healthcare Provider Details

I. General information

NPI: 1528053006
Provider Name (Legal Business Name): PETER M. DAHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 09/17/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BURGESS HEALTH CENTER 1600 DIAMOND AVE
ONAWA IA
51040-5104
US

IV. Provider business mailing address

11753 PACIFIC ST
OMAHA NE
68154-3444
US

V. Phone/Fax

Practice location:
  • Phone: 712-423-2311
  • Fax:
Mailing address:
  • Phone: 402-290-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19356
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19356
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: