Provider Demographics
NPI:1740601038
Name:DEAN ANTONSON MD PC
Entity Type:Organization
Organization Name:DEAN ANTONSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANTONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-552-2100
Mailing Address - Street 1:PO BOX 540221
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-0221
Mailing Address - Country:US
Mailing Address - Phone:402-552-2100
Mailing Address - Fax:402-552-2160
Practice Address - Street 1:4242 FARNAM ST STE 490
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2850
Practice Address - Country:US
Practice Address - Phone:402-552-2100
Practice Address - Fax:402-552-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty