Provider Demographics
NPI:1528053006
Name:DAHER, PETER M (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:DAHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11753 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3444
Mailing Address - Country:US
Mailing Address - Phone:402-290-1212
Mailing Address - Fax:
Practice Address - Street 1:BURGESS HEALTH CENTER
Practice Address - Street 2:1600 DIAMOND AVE
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-5104
Practice Address - Country:US
Practice Address - Phone:712-423-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19356207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE9685OtherMIDLANDS CHOICE
NE0106035OtherAMERICHOICE
NE30105 GRP: 7553OtherBCBS
NE47-075591500Medicaid
IA8967893Medicaid
NEP00312875 GRP CK4096OtherRAILROAD MEDICARE
NE9685OtherMIDLANDS CHOICE
IA8967893Medicaid
NE0106035OtherAMERICHOICE