Provider Demographics
NPI:1922064708
Name:TADDEUCCI, RAYMOND J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:TADDEUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S 70TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-7901
Mailing Address - Country:US
Mailing Address - Phone:402-441-4760
Mailing Address - Fax:402-441-4764
Practice Address - Street 1:1001 S 70TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-7901
Practice Address - Country:US
Practice Address - Phone:402-441-4760
Practice Address - Fax:402-441-4764
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23735208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0722496Medicaid
NE1701125OtherUHC - SURGICAL ASSOC
NE68510A005OtherWPS/TRIWEST - SURGICAL
P00331861OtherRRM
NE250827OtherMIDLANDS - PROMED
NE38140OtherBCBS - SURGICAL ASSOC
NE30806OtherBCBS - PROMED
NE250827OtherMIDLANDS - SURGICAL ASSOC
KS200632720AMedicaid
MO209884402Medicaid
P00331861OtherRRM
IA0722496Medicaid
280675Medicare PIN