Healthcare Provider Details

I. General information

NPI: 1619717261
Provider Name (Legal Business Name): TUCKER DEAN VAHLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983075 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3075
US

IV. Provider business mailing address

983075 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3075
US

V. Phone/Fax

Practice location:
  • Phone: 402-595-2275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9896
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: