Healthcare Provider Details

I. General information

NPI: 1437350576
Provider Name (Legal Business Name): NEBRASKA DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 S 27TH STREET SUITE 103
LINCOLN NE
68512-1664
US

IV. Provider business mailing address

5533 S 27TH STREET SUITE 103
LINCOLN NE
68512-1664
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-7000
  • Fax: 402-423-9399
Mailing address:
  • Phone: 402-423-7000
  • Fax: 702-423-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number17872
License Number StateNE

VIII. Authorized Official

Name: REX F LARGEN
Title or Position: PRESIDENT
Credential: MD
Phone: 402-423-7000