Provider Demographics
NPI:1437350576
Name:NEBRASKA DERMATOLOGY LLC
Entity Type:Organization
Organization Name:NEBRASKA DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REX
Authorized Official - Middle Name:F
Authorized Official - Last Name:LARGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-423-7000
Mailing Address - Street 1:5533 S 27TH STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1664
Mailing Address - Country:US
Mailing Address - Phone:402-423-7000
Mailing Address - Fax:702-423-9399
Practice Address - Street 1:5533 S 27TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1664
Practice Address - Country:US
Practice Address - Phone:402-423-7000
Practice Address - Fax:402-423-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17872207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE269310Medicare PIN