Provider Demographics
NPI:1861487829
Name:STALDER, THOMAS SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SCOTT
Last Name:STALDER
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 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-413-3531
Mailing Address - Fax:402-413-3535
Practice Address - Street 1:5401 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2150
Practice Address - Country:US
Practice Address - Phone:402-413-3531
Practice Address - Fax:402-413-3535
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16935207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096555013OtherMEDICARE
NE47043959911Medicaid
271578Medicare PIN
NE096555013OtherMEDICARE