Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 31560 | NE |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 36080 | MN |
NPI | 1619929916 |
---|---|
Provider Name | Dr. John C. Ely |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 04/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036113303 | (05) | IL |
E94088 | (02) | IL |