Provider Demographics
NPI:1053369900
Name:BRACKER, TROY D (MD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:D
Last Name:BRACKER
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:5908 S 142ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2800
Practice Address - Country:US
Practice Address - Phone:402-354-1900
Practice Address - Fax:402-354-1910
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19921207Q00000X
CO47278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731741Medicaid
NE47068731706Medicaid
NE47068731734Medicaid
NE10024994800Medicaid
IA1053369900Medicaid
NE47068731749Medicaid
IA1053369900Medicaid