Basic Information
| Provider Information | |||||||||
| NPI: | 1225241300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORTEMAKER | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4524 POPPLETON AVE | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681062044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029642014 | ||||||||
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| Practice Location | |||||||||
| Address1: | 986690 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681986690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025594081 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 5008 | NE | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.