Healthcare Provider Details

I. General information

NPI: 1922059864
Provider Name (Legal Business Name): CHRISTOPHER SCOTT KUDRON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S 70TH ST NEBRASKA ORTHOPAEDIC AND SPORTS MEDICINE P.C. SUITE 200
LINCOLN NE
68510-2471
US

IV. Provider business mailing address

575 S 70TH ST NEBRASKA ORTHOPAEDIC AND SPORTS MEDICINE P.C. SUITE 200
LINCOLN NE
68510-2471
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-3322
  • Fax: 402-488-1172
Mailing address:
  • Phone: 402-488-3322
  • Fax: 402-488-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number991
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: