Provider Demographics
NPI:1073617312
Name:REED, JERRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:A
Last Name:REED
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 1:1910 ST JAMES ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1656
Mailing Address - Country:US
Mailing Address - Phone:402-489-9158
Mailing Address - Fax:
Practice Address - Street 1:5401 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2134
Practice Address - Country:US
Practice Address - Phone:402-483-9531
Practice Address - Fax:402-483-9494
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1997072OtherIOWA MEDICAID
NE7600120OtherUNITED HEALTH CARE
NE2300157OtherAMERICHOICE
NE5832OtherMIDLANDS CHOICE
NE02662OtherBLUE CROSS BLUE SHIELD
NE5832OtherMIDLANDS CHOICE
D05198Medicare UPIN