Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5456 | NE |
Y | 213EG0000X | General Practice | 5456 | NE |
NPI | 1003026782 |
---|---|
Provider Name | Dr. Mark Thomas Chase |
First Address | Omaha, NE 68124-3138 |
Second Address | Omaha, NE 68124-3138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47-0736187-00 | (05) | NE |