MEDICARE: JOSE GARY B NADALA MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	22502	NE

General Provider Information

NPI Number	:	1396882916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE GARY B NADALA MD

Provider Business Mailing Address
First Line	:	2222 S 16TH ST
Second Line	:	STE 410
City	:	LINCOLN
State	:	NE
Zip	:	68502-3785
Country	:	US
Telephone Number	:	402-474-1511
Fax Number	:	402-474-1611

Provider Business Practice Location Address
First Line	:	2222 S 16TH ST
Second Line	:	STE 410
City	:	LINCOLN
State	:	NE
Zip	:	68502-3785
Country	:	US
Telephone Number	:	402-474-1511
Fax Number	:	402-474-1611

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	06/22/2021

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