Provider Demographics
NPI:1053319046
Name:HRNICEK, GORDON JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:JAMES
Last Name:HRNICEK
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 1:1049 GRANITE WAY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-6202
Mailing Address - Country:US
Mailing Address - Phone:402-944-4173
Mailing Address - Fax:
Practice Address - Street 1:1049 GRANITE WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-6202
Practice Address - Country:US
Practice Address - Phone:402-944-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01708OtherBCBS NUMBER
NE47059252300Medicaid
NE01708OtherBCBS NUMBER
NE110073159Medicare ID - Type UnspecifiedRR INDIV. MEDICARE #
NE47059252300Medicaid