Provider Demographics
NPI:1609813948
Name:BRADDOCK FINNEGAN HELGET DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:BRADDOCK FINNEGAN HELGET DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-390-0333
Mailing Address - Street 1:7911 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3104
Mailing Address - Country:US
Mailing Address - Phone:402-390-0333
Mailing Address - Fax:402-390-9632
Practice Address - Street 1:7911 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3104
Practice Address - Country:US
Practice Address - Phone:402-390-0333
Practice Address - Fax:402-390-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025333700Medicaid
NE099793Medicare ID - Type Unspecified