Provider Demographics
NPI:1639149883
Name:STRNOT, RUDOLF JR (MD)
Entity Type:Individual
Prefix:
First Name:RUDOLF
Middle Name:
Last Name:STRNOT
Suffix:JR
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 1:600 N COTNER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-466-2484
Mailing Address - Fax:402-466-2507
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-466-2484
Practice Address - Fax:402-466-2507
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12281207N00000X, 207ND0101X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000989OtherBCBS OF NEBRASKA
NE$$$$$$$$$01Medicaid
NEB67557Medicare UPIN
MT070014822Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NE276403Medicare ID - Type Unspecified