Provider Demographics
NPI:1265546642
Name:ANZALONE, TEMPLE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:TEMPLE
Middle Name:ANN
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEMPLE
Other - Middle Name:ANN
Other - Last Name:BRANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6901 N 72ND ST
Mailing Address - Street 2:ATTN: HOSPITAL MEDICINE DEPT.
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1709
Mailing Address - Country:US
Mailing Address - Phone:855-524-4001
Mailing Address - Fax:402-572-3206
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:855-524-4001
Practice Address - Fax:402-398-5589
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD43638207R00000X
NE22803207R00000X, 208M00000X
IAMD-43638208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI14843Medicare UPIN
NE086032Medicare ID - Type UnspecifiedMEDICARE
NEP00148051Medicare PIN