Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 016484 | ME |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 21263 | NE |
NPI | 1104803931 |
---|---|
Provider Name | Dr. Geoffrey M Mccullen |
First Address | Lincoln, NE 68510-4120 |
Second Address | Lincoln, NE 68510-4120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 26/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47061995513 | (05) | NE |