Healthcare Provider Details

I. General information

NPI: 1699868596
Provider Name (Legal Business Name): EAR NOSE & THROAT - HEAD AND NECK SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11704 W CENTER RD SUITE 211
OMAHA NE
68144-4375
US

IV. Provider business mailing address

11704 W CENTER RD SUITE 211
OMAHA NE
68144-4375
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-7050
  • Fax: 402-393-2814
Mailing address:
  • Phone: 402-393-7050
  • Fax: 402-393-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number18235
License Number StateNE

VIII. Authorized Official

Name: DR. THOMAS JAMES DOBLEMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-393-7050