Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 7911 | NE |
NPI | 1093244980 |
---|---|
Provider Name | Dr. Joseph Paul Menousek |
First Address | Omaha, NE 68198-2035 |
Second Address | Omaha, NE 68198-2035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2017 |
Last Update Date | 05/06/2017 |