Healthcare Provider Details

I. General information

NPI: 1316182785
Provider Name (Legal Business Name): GATEWAY DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COTNER BLVD SUITE 311
LINCOLN NE
68505-2343
US

IV. Provider business mailing address

600 N COTNER BLVD SUITE 311
LINCOLN NE
68505-2343
US

V. Phone/Fax

Practice location:
  • Phone: 402-467-4361
  • Fax: 402-467-1864
Mailing address:
  • Phone: 402-467-4361
  • Fax: 402-467-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A BIGLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-467-4361