Provider Demographics
NPI:1356436638
Name:NETZ, DOUGLAS D (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:NETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17962207RI0011X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100180450 BMedicaid
NE10026072600Medicaid
NE47070592306Medicaid
NE47070592313Medicaid
NE47070592305Medicaid
IA0565754Medicaid
NE10026072200Medicaid
NE47070592301Medicaid
NE47070592302Medicaid
NE10026072000Medicaid
NE10026072300Medicaid
NE10026072500Medicaid
NE47070592300Medicaid
NE10026072400Medicaid
NE060063775Medicare PIN
NE47070592302Medicaid
NE47070592306Medicaid
NE10026072300Medicaid
KS102557Medicare PIN
NE10026072200Medicaid
NE47070592300Medicaid
NE274133Medicare PIN