Provider Demographics
NPI:1881914083
Name:MOES, CHAD L (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:L
Last Name:MOES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CENTER
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:402-559-6195
Mailing Address - Fax:
Practice Address - Street 1:110 N 175TH ST #2000
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3515
Practice Address - Country:US
Practice Address - Phone:402-596-4411
Practice Address - Fax:402-596-4410
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27090207Q00000X
NE6420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731734Medicaid
IA1881914083Medicaid
NE47068731731734Medicaid
NE47068731741Medicaid
NE10025464000Medicaid
NE47068731749Medicaid
NE10025464000Medicaid