Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 19930 | NE |
Y | 207RI0011X | Interventional Cardiology | 19930 | NE |
NPI | 1104932722 |
---|---|
Provider Name | Clyde R Meckel |
First Address | Lincoln, NE 68506-1275 |
Second Address | Lincoln, NE 68506-1275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100418760A | (05) | KS |
100418760C | (05) | KS |
1537191 | (05) | IA |
208462200 | (05) | MO |
47084496100 | (05) | NE |
F81530 | (02) | NE |