Provider Demographics
NPI:1144237041
Name:IMES, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:IMES
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 1:1275 SAGE ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-3227
Mailing Address - Country:US
Mailing Address - Phone:308-436-2101
Mailing Address - Fax:308-436-3681
Practice Address - Street 1:1275 SAGE ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-3227
Practice Address - Country:US
Practice Address - Phone:308-436-2101
Practice Address - Fax:308-436-3681
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12682OtherSTATE LICENSE
080074004OtherMEDICARE RAILROAD
283821AOtherRURAL HEALTH
080074004OtherMEDICARE RAILROAD
283821AOtherRURAL HEALTH
265980Medicare PIN