Healthcare Provider Details

I. General information

NPI: 1063607414
Provider Name (Legal Business Name): DOUGLAS M. LAFLAN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 CHASE AVE
CREIGHTON NE
68729-2893
US

IV. Provider business mailing address

804 CHASE AVENUE PO BOX 110
CREIGHTON NE
68729-0110
US

V. Phone/Fax

Practice location:
  • Phone: 402-358-5335
  • Fax: 402-358-3598
Mailing address:
  • Phone: 402-358-5335
  • Fax: 402-358-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number12187
License Number StateNE

VIII. Authorized Official

Name: DR. DOUGLAS M LAFLAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-358-5335