Healthcare Provider Details

I. General information

NPI: 1104905538
Provider Name (Legal Business Name): DEAN RUSSELL FORGEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S 70TH ST SUITE 102
LINCOLN NE
68506-1566
US

IV. Provider business mailing address

1520 S 70TH ST SUITE 102
LINCOLN NE
68506-1566
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-2323
  • Fax: 402-483-6184
Mailing address:
  • Phone: 402-483-2323
  • Fax: 402-483-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17525
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: