Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 24055 | NE |
N | 207P00000X | Emergency Physician | 5025 | NE |
NPI | 1013066844 |
---|---|
Provider Name | Chad E Branecki |
First Address | Omaha, NE 68198-8095 |
Second Address | Omaha, NE 68198-8095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
24055 | PERMNANT STATE LICENSE (01) | NE |
5025 | STATE LICENSE (01) | NE |