Healthcare Provider Details

I. General information

NPI: 1134498330
Provider Name (Legal Business Name): DANIEL TIMOTHY SMITH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST STE 506
LINCOLN NE
68506-1279
US

IV. Provider business mailing address

1500 S 48TH ST STE 506
LINCOLN NE
68506-1279
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-1110
  • Fax: 402-489-8492
Mailing address:
  • Phone: 402-489-1110
  • Fax: 402-489-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number29979
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: