Provider Demographics
NPI:1629033972
Name:MCGILL, EDWARD MCDERMOTT (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MCDERMOTT
Last Name:MCGILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10707 PACIFIC ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4762
Mailing Address - Country:US
Mailing Address - Phone:402-399-8055
Mailing Address - Fax:402-399-8005
Practice Address - Street 1:10707 PACIFIC STREETT
Practice Address - Street 2:SUITE 205
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4762
Practice Address - Country:US
Practice Address - Phone:402-399-8055
Practice Address - Fax:402-399-8005
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE20457207W00000X
IA32762207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47062838702Medicaid
NE275351Medicare ID - Type UnspecifiedMEDICARE NUMBER
NEG69479Medicare UPIN