Provider Demographics
NPI:1548219462
Name:DETERMAN, SAMUEL JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAMES
Last Name:DETERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17816 HOLMES CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3406
Mailing Address - Country:US
Mailing Address - Phone:402-895-2583
Mailing Address - Fax:
Practice Address - Street 1:17816 HOLMES CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3406
Practice Address - Country:US
Practice Address - Phone:402-895-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE296213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery