Provider Demographics
NPI:1699763938
Name:BUDDECKE, DONALD EUGENE JR (DPM)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EUGENE
Last Name:BUDDECKE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 SAMSON WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4307
Mailing Address - Country:US
Mailing Address - Phone:402-331-6387
Mailing Address - Fax:402-331-6537
Practice Address - Street 1:2705 SAMSON WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4307
Practice Address - Country:US
Practice Address - Phone:402-991-8999
Practice Address - Fax:402-331-6537
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00675213ES0103X
NE301213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1427348838OtherGROUP NPI, NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
NE10025518000Medicaid
NE10025518100Medicaid
NE10025518200Medicaid
NE10025640100Medicaid
NE1427348838OtherGROUP NPI, NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
NENA1914Medicare PIN
NE10025640100Medicaid
NENA1914003Medicare PIN
NE10025518100Medicaid
NENA1915003Medicare PIN