Provider Demographics
NPI:1801855002
Name:FOOTE, GREGG (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:FOOTE
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:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:NE
Mailing Address - Zip Code:68876-0609
Mailing Address - Country:US
Mailing Address - Phone:308-647-4900
Mailing Address - Fax:308-647-5378
Practice Address - Street 1:4600 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1664
Practice Address - Country:US
Practice Address - Phone:308-647-4900
Practice Address - Fax:308-647-5378
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE144452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B90955Medicare UPIN
NE089215Medicare ID - Type Unspecified