Healthcare Provider Details

I. General information

NPI: 1376508960
Provider Name (Legal Business Name): RANDALL T DUCKERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N KANSAS AVE STE 100
HASTINGS NE
68901-4470
US

IV. Provider business mailing address

715 N ST JOSEPH AVE
HASTINGS NE
68901-4451
US

V. Phone/Fax

Practice location:
  • Phone: 402-460-5899
  • Fax: 402-460-5898
Mailing address:
  • Phone: 402-460-5836
  • Fax: 402-460-5829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number20144
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: