MEDICARE: DR. RANDALL T DUCKERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	20144	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00060114	OTHER	NE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376508960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL T DUCKERT M.D.

Provider Business Mailing Address
First Line	:	715 N ST JOSEPH AVE
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-4451
Country	:	US
Telephone Number	:	402-460-5836
Fax Number	:	402-460-5829

Provider Business Practice Location Address
First Line	:	815 N KANSAS AVE
Second Line	:	STE 100
City	:	HASTINGS
State	:	NE
Zip	:	68901-4470
Country	:	US
Telephone Number	:	402-460-5899
Fax Number	:	402-460-5898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	02/08/2022

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