Provider Demographics
NPI:1265440572
Name:TEGT, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TEGT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:575 S 70TH ST
Practice Address - Street 2:STE 440
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-484-5500
Practice Address - Fax:402-484-5501
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE14956207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01799OtherBCBS
1000050OtherUHC
SD7777282Medicaid
IA1940130Medicaid
2751OtherMIDLANDS CHOICE
NE10024991800Medicaid
1000050OtherUHC
P00010257Medicare PIN
276545Medicare PIN