Provider Demographics
NPI:1508064833
Name:ROBERT J. FONDA, M.D., P.C.
Entity Type:Organization
Organization Name:ROBERT J. FONDA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FONDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-391-5050
Mailing Address - Street 1:8601 W. DODGE RD.
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3457
Mailing Address - Country:US
Mailing Address - Phone:402-391-5050
Mailing Address - Fax:402-391-3017
Practice Address - Street 1:8601 W. DODGE RD.
Practice Address - Street 2:SUITE 118
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3457
Practice Address - Country:US
Practice Address - Phone:402-391-5050
Practice Address - Fax:402-391-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty