Provider Demographics
NPI:1457301236
Name:SCOTT-MORDHORST, TINA R (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:SCOTT-MORDHORST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:402-296-6009
Mailing Address - Fax:402-296-6202
Practice Address - Street 1:988102 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-8102
Practice Address - Country:US
Practice Address - Phone:402-296-6009
Practice Address - Fax:402-296-6202
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE20350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE20350OtherNE LICENSE