Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1609 | NE |
N | 207QA0505X | Family Doctor - Adult Medicine | 1609 | NE |
NPI | 1043604614 |
---|---|
Provider Name | Justin Morar |
First Address | Omaha, NE 68103-0755 |
Second Address | Omaha, NE 68114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 20/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10026480100 | (05) | NE |
1043604614 | (05) | IA |
47068731734 | (05) | NE |
47068731741 | (05) | NE |
47068731742 | (05) | NE |
47068731749 | (05) | NE |