Healthcare Provider Details

I. General information

NPI: 1427069442
Provider Name (Legal Business Name): DALE MEIER FOUNTAIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5835 VINE ST
LINCOLN NE
68505-2847
US

IV. Provider business mailing address

5835 VINE ST PO BOX 5505
LINCOLN NE
68505-2847
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-5677
  • Fax: 402-466-5677
Mailing address:
  • Phone: 402-466-5677
  • Fax: 402-466-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number218
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: