Provider Demographics
NPI:1093811036
Name:START, JEFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFREY
Middle Name:
Last Name:START
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 DRENTHE LAAN
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W FRANCIS ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0614
Practice Address - Country:US
Practice Address - Phone:308-568-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4357207QS1201X
NE1933207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99585Medicare UPIN
PAP00104603OtherRR MEDICARE
PA168641Medicare PIN
PA1023964020001Medicaid
PA1562282OtherBLUE CROSS
PA238646OtherHEALTHAMERICA
PA075941Medicare PIN
PAH99585Medicare UPIN
PA325649OtherUPMC