Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301051110 | MI |
N | 2080P0204X | Pediatric Emergency Doctor | 23799 | NE |
N | 2080P0204X | Pediatric Emergency Doctor | 4301051110 | MI |
NPI | 1306929054 |
---|---|
Provider Name | Thomas J Deegan |
First Address | Omaha, NE 68114-4113 |
Second Address | Omaha, NE 68114-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3086715 | (05) | MI |
B49171 | (02) | MI |