Provider Demographics
NPI:1073599890
Name:KING, JEREMY C (DO)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:C
Last Name:KING
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:402-595-2275
Mailing Address - Fax:402-595-1970
Practice Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1520
Practice Address - Country:US
Practice Address - Phone:402-595-2275
Practice Address - Fax:402-595-1970
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-02-22
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Provider Licenses
StateLicense IDTaxonomies
NE566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE566OtherNE STATE LICENSE