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General NPI Number Information
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NPI Number | 1699117457
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Entity Type | Organization
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Legal Business Name | GREATER NEBRASKA DERMATOLOGY CLINIC, P.C.
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 2509 HALLIGAN DRIVE SUITE E
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City | NORTH PLATTE
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State | NE
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Zip | 69101-7858
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Country | US
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Telephone | 402-310-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 HALLIGAN DRIVE SUITE E
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City | NORTH PLATTE
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State | NE
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Zip | 69101-7858
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Country | US
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Telephone | 402-310-3310
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | DANIEL MOSEL
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Credential |
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Telephone | 402-310-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 27070
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License Number State | NE
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