Healthcare Provider Details

I. General information

NPI: 1760976385
Provider Name (Legal Business Name): ERIC SPENCER WEST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982185 NEBRASKA MEDICAL CENTER OMAHA
OMAHA NE
68198-2185
US

IV. Provider business mailing address

982185 NEBRASKA MEDICAL CENTER OMAHA
OMAHA NE
68198-2185
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5380
  • Fax: 402-559-5137
Mailing address:
  • Phone: 402-559-5380
  • Fax: 402-559-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8331
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: