Basic Information
| Provider Information | |||||||||
| NPI: | 1265840243 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PERSON | ||||||||
| FirstName: | AUSTIN | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 N 30TH ST CU DEPT OF SURGERY | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681312137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022804669 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 N 30TH ST CU DEPT OF SURGERY | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681312137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022804669 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 33755 | NE | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | 7300 | NE | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.