Basic Information
| Provider Information | |||||||||
| NPI: | 1780979195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAYER | ||||||||
| FirstName: | BENJAMIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1240 ARIES DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685129100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024201300 | ||||||||
| FaxNumber: | 4024201326 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 ARIES DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685129100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024201300 | ||||||||
| FaxNumber: | 4024201326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207Q00000X | TEP6487 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 27378 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.