Healthcare Provider Details

I. General information

NPI: 1275600587
Provider Name (Legal Business Name): DOUGLAS F SPELLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14092 BOYS TOWN HOSPITAL ROAD
BOYS TOWN NE
68010
US

IV. Provider business mailing address

555 N 30TH ST
OMAHA NE
68131-2136
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-1449
  • Fax: 531-355-0001
Mailing address:
  • Phone: 402-280-8100
  • Fax: 402-280-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number18135
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: