Provider Demographics
NPI:1699117457
Name:GREATER NEBRASKA DERMATOLOGY CLINIC, P.C.
Entity type:Organization
Organization Name:GREATER NEBRASKA DERMATOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-310-3310
Mailing Address - Street 1:2509 HALLIGAN DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-7858
Mailing Address - Country:US
Mailing Address - Phone:402-310-3310
Mailing Address - Fax:
Practice Address - Street 1:2509 HALLIGAN DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-7858
Practice Address - Country:US
Practice Address - Phone:402-310-3310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27070207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty