Healthcare Provider Details

I. General information

NPI: 1558401414
Provider Name (Legal Business Name): FRED MILLER JAMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COTNER BLVD SUITE 116
LINCOLN NE
68505-2343
US

IV. Provider business mailing address

600 N COTNER BLVD SUITE 116
LINCOLN NE
68505-2343
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-6677
  • Fax: 402-466-6724
Mailing address:
  • Phone: 402-466-6677
  • Fax: 402-466-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number260
License Number StateNE

VIII. Authorized Official

Name: MS. ALTA L BRODD
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-466-6677