Healthcare Provider Details

I. General information

NPI: 1811940596
Provider Name (Legal Business Name): ANTONIO J BELTRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TIGER LILY RD STE 100
LINCOLN NE
68516-5587
US

IV. Provider business mailing address

4101 TIGER LILY RD STE 100
LINCOLN NE
68516-5587
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-7000
  • Fax: 402-420-6969
Mailing address:
  • Phone: 402-420-7000
  • Fax: 402-420-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME76056
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number36111
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: