Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 16805 | NE |
NPI | 1013982370 |
---|---|
Provider Name | Dr. Douglas E. Brouillette |
First Address | Omaha, NE 68114-4057 |
Second Address | Omaha, NE 68114-4057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 08/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025290600 | (05) | NE |
47077295213 | (05) | NE |
B90962 | (02) |