Provider Demographics
NPI:1851408637
Name:DEBOISE, DOUGLAS ALEX (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALEX
Last Name:DEBOISE
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 1:301 S 70TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2469
Mailing Address - Country:US
Mailing Address - Phone:402-483-7641
Mailing Address - Fax:402-483-7641
Practice Address - Street 1:301 S 70TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2469
Practice Address - Country:US
Practice Address - Phone:402-483-7641
Practice Address - Fax:402-483-7641
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16816207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082083213Medicaid
277005Medicare ID - Type Unspecified
NE47082083213Medicaid