Healthcare Provider Details

I. General information

NPI: 1215923578
Provider Name (Legal Business Name): ANTONIO B. SAQUETON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 CENTER ST SUITE 100
OMAHA NE
68106-3251
US

IV. Provider business mailing address

4951 CENTER ST STE 100
OMAHA NE
68106-3252
US

V. Phone/Fax

Practice location:
  • Phone: 402-556-9220
  • Fax:
Mailing address:
  • Phone: 402-556-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19126
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: