Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 15290 | NE |
NPI | 1073602462 |
---|---|
Provider Name | Dr. Alan G Fuss |
First Address | Omaha, NE 68114-4113 |
Second Address | Omaha, NE 68114-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0937987 | (05) | IA |
D00629 | BCBS (01) | NE |