Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 12515 | NE |
Y | 208600000X | Surgeon | 12515 | NE |
N | 2086S0122X | Plastic and Reconstructive Surgery | 12515 | NE |
NPI | 1033256920 |
---|---|
Provider Name | Steven B Black |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-7400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 13/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47061923313 | (05) | NE |
F01980 | (02) |