Healthcare Provider Details

I. General information

NPI: 1376548537
Provider Name (Legal Business Name): DAVID A DANFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

804 S 129TH AVE
OMAHA NE
68154-2983
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-4350
  • Fax: 402-955-4356
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number17412
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: