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General NPI Number Information
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NPI Number | 1376342998
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Entity Type | Individual
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Provider Name | GARY GEORGE
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Gender | Male
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 7110 F ST
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City | OMAHA
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State | NE
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Zip | 68117-1014
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Country | US
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Telephone | 712-328-2638
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Fax |
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Provider Business Mailing Address
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Address Line | 2565 NEWPORT AVE
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City | OMAHA
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State | NE
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Zip | 68112-3325
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Country | US
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Telephone | 402-658-6652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | H12145135
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License Number State | NE
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