Healthcare Provider Details

I. General information

NPI: 1861487829
Provider Name (Legal Business Name): THOMAS SCOTT STALDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 SOUTH ST
LINCOLN NE
68506-2150
US

IV. Provider business mailing address

5401 SOUTH ST
LINCOLN NE
68506-2150
US

V. Phone/Fax

Practice location:
  • Phone: 402-413-3531
  • Fax: 402-413-3535
Mailing address:
  • Phone: 402-413-3531
  • Fax: 402-413-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number16935
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: