Basic Information
Provider Information
NPI: 1093804700
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEFFES
FirstName: PAUL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12508 WILLIAM ST
Address2:  
City: OMAHA
State: NE
PostalCode: 681441326
CountryCode: US
TelephoneNumber: 4023334317
FaxNumber: 4027175050
Practice Location
Address1: 7710 MERCY RD
Address2:  
City: OMAHA
State: NE
PostalCode: 681242372
CountryCode: US
TelephoneNumber: 4027173636
FaxNumber: 4027175050
Other Information
ProviderEnumerationDate: 10/12/2006
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X12988NEY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

ID Information
IDTypeStateIssuerDescription
0013801NEBCBS OF NEOTHER
391636105IA MEDICAID


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