Basic Information
| Provider Information | |||||||||
| NPI: | 1528053006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAHER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11753 PACIFIC ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681543444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022901212 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BURGESS HEALTH CENTER | ||||||||
| Address2: | 1600 DIAMOND AVE | ||||||||
| City: | ONAWA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510405104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7124232311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 19356 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 19356 | NE | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9685 | 01 | NE | MIDLANDS CHOICE | OTHER | 0106035 | 01 | NE | AMERICHOICE | OTHER | 30105 GRP: 7553 | 01 | NE | BCBS | OTHER | 47-075591500 | 05 | NE | MEDICAID | 8967893 | 05 | IA | MEDICAID | P00312875 GRP CK4096 | 01 | NE | RAILROAD MEDICARE | OTHER |