Provider Demographics
NPI:1508818188
Name:GOLDNER, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:GOLDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W DODGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3321
Mailing Address - Country:US
Mailing Address - Phone:402-354-2000
Mailing Address - Fax:
Practice Address - Street 1:8901 W DODGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3321
Practice Address - Country:US
Practice Address - Phone:402-354-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE109952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0958330Medicaid
IA0958330Medicaid
B68134Medicare UPIN