Provider Demographics
NPI:1619016409
Name:NIEMANN, DOUGLAS FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FRANCIS
Last Name:NIEMANN
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 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:EMILE @ 42ND STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1045
Practice Address - Country:US
Practice Address - Phone:402-559-1010
Practice Address - Fax:402-559-1011
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE237592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00779OtherBC/BS OF NE WHITE RIVER IMAGING
IA1619016409Medicaid
NE10025173600Medicaid
NE00780OtherBC/BS OF NE CENTRAL NEBRASKA IMAGING
NE10025186700Medicaid
NE10025248800Medicaid
NE099669Medicare PIN
NE099580002Medicare PIN
NE099591Medicare PIN
NE00779OtherBC/BS OF NE WHITE RIVER IMAGING
NE10025186700Medicaid
NENA1023Medicare PIN