Healthcare Provider Details

I. General information

NPI: 1609878826
Provider Name (Legal Business Name): GARY D CUDDY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 2ND ST
ONEILL NE
68763-1519
US

IV. Provider business mailing address

PO BOX 270
ONEILL NE
68763-0270
US

V. Phone/Fax

Practice location:
  • Phone: 402-336-2900
  • Fax:
Mailing address:
  • Phone: 402-336-2901
  • Fax: 402-336-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number633
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: