Healthcare Provider Details

I. General information

NPI: 1902367337
Provider Name (Legal Business Name): DR. BLAKE VOLKMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W DODGE RD
OMAHA NE
68114-3327
US

IV. Provider business mailing address

140 N 41ST ST APT 3
OMAHA NE
68131-2497
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-8990
  • Fax:
Mailing address:
  • Phone: 970-305-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35034
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: