Healthcare Provider Details

I. General information

NPI: 1841721826
Provider Name (Legal Business Name): ERIC DONALD FORNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N 190TH PLZ STE 2200
ELKHORN NE
68022-3984
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-815-2300
  • Fax: 402-815-1045
Mailing address:
  • Phone: 402-354-5451
  • Fax: 402-354-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number04-51431
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number37274
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number315883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: