Healthcare Provider Details

I. General information

NPI: 1578644035
Provider Name (Legal Business Name): TEODORO SEGURA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16945 FRANCES ST
OMAHA NE
68130-2312
US

IV. Provider business mailing address

16945 FRANCES ST
OMAHA NE
68130-2312
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-7400
  • Fax: 402-397-0115
Mailing address:
  • Phone: 402-397-7400
  • Fax: 402-397-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20827
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: