Healthcare Provider Details

I. General information

NPI: 1871861609
Provider Name (Legal Business Name): NAGI T AYOUB MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 NICHOLAS ST STE 300
OMAHA NE
68114-2249
US

IV. Provider business mailing address

9900 NICHOLAS ST STE 300
OMAHA NE
68114-2249
US

V. Phone/Fax

Practice location:
  • Phone: 402-829-6384
  • Fax: 402-829-6495
Mailing address:
  • Phone: 402-829-6384
  • Fax: 402-829-6495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NAGI T AYOUB
Title or Position: PRESIDENT
Credential: MD
Phone: 402-829-6384