Healthcare Provider Details

I. General information

NPI: 1912005109
Provider Name (Legal Business Name): BASLER SKIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 STOCKWELL ST
LINCOLN NE
68502-5755
US

IV. Provider business mailing address

2625 STOCKWELL ST
LINCOLN NE
68502-5755
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-3335
  • Fax: 402-421-2625
Mailing address:
  • Phone: 402-421-3335
  • Fax: 402-421-2625

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 Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: RODNEY SW BASLER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 402-421-3335