Basic Information
| Provider Information | |||||||||
| NPI: | 1508827692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUY | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6901 N 72ND ST | ||||||||
| Address2: | STE 3300N | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025723300 | ||||||||
| FaxNumber: | 4025723305 | ||||||||
| Practice Location | |||||||||
| Address1: | 426 E 22ND ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027277796 | ||||||||
| FaxNumber: | 4027279574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 16729 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P00008056 | 01 | PALMETTO - GBA | OTHER | 47076868513 | 05 | NE | MEDICAID | 4975912 | 05 | IA | MEDICAID |