Healthcare Provider Details

I. General information

NPI: 1275834731
Provider Name (Legal Business Name): JEREMY CHARLES TOFFLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982185 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2185
US

IV. Provider business mailing address

1337 S 101ST ST APT 212
OMAHA NE
68124-1093
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5380
  • Fax:
Mailing address:
  • Phone: 304-685-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6275
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: